In-state Providers: Maximum Allowable Fees

(A) The Executive Office of Health and Human Services (EOHHS) determines the payment rate for covered services in accordance with 101 CMR 317.00: Rates for Medicine Services, 101 CMR 314.00: Rates for Dental Services; 101 CMR 316.00: Rates for Surgery and Anesthesia Services; 101 CMR 318.00: Rates for Radiology Services; 101 CMR 320.00: Rates for Clinical Laboratory Services; and 101 CMR 444.00: Rates for Certain Substance Use Disorder Services. Payment is subject to the conditions, exclusions, and limitations set forth in 130 CMR 449.000 and 130 CMR 450.000: Administrative and Billing Regulations. (B) Administrative Operations. Payment by the MassHealth agency for covered services includes payment for administrative operations and for all aspects of service delivery not explicitly included in 130 CMR 449.000, such as, but not limited to (1) staff supervision or consultation with another staff member; (2) providing information for the coordination of referrals; and (3) recordkeeping.