General Provisions

(1) Scope, Purpose and Effective Date. 114.1 CMR 41.00 establishes payment rates effective April 1, 2009, for services provided to Industrial Accident Patients by Acute and Non-acute Hospitals under M.G.L. c. 152, the Workers’ Compensation Act. Payment rates for services provided to industrial accident patients by other providers are set forth in 114.3 CMR 40.00. Program policies relating to medical necessity and clinical appropriateness are determined pursuant to M.G.L. c. 152 and 452 CMR 6.00. Hospitals must comply with the Department of Industrial Accidents billing requirements under 452 CMR 7.02. (2) Coverage. The payment rates set forth in 114.3 CMR 41.00 are full payment for services provided under M.G.L. c. 152, § 13, including any related administrative or overhead costs. The insurer, employer and health care service provider may agree upon a different payment rate than that established by 114.1 CMR 41.00. No Industrial Accident Patient may be held liable for the payment for health care services determined compensable under M.G.L. c. 152, § 13. (3) Authority. 114.1 CMR 41.00 is adopted pursuant to M.G.L. c. 118G and M.G.L. c. 152.