101 CMR 304.01 - General Provisions
(1)
Scope and Purpose.
101 CMR
304.00 governs the payment rates to be used by
governmental units and purchasers under M.G.L. c. 152 (the Workers'
Compensation Act) for community health center services.
(2)
Applicable Dates of
Service. Rates in
101 CMR
304.00 apply for dates of service provided on or after
January 1, 2023, unless otherwise indicated.
(3)
Coverage. The
rates of payment under
101 CMR
304.00 constitute full compensation for community
health center services provided to publicly aided individuals as well as full
compensation for necessary administration, professional supervision, and
supporting services associated with patient care. Any client resources or
third-party payments received on behalf of a publicly aided individual will
reduce, by that amount, the amount of the purchasing governmental unit's
obligation for services rendered to the publicly aided individual.
(4)
Disclaimer of Authorization
of Services.
101 CMR
304.00 is not authorization for or approval of the
services for which rates are determined. The purchasing governmental unit or
purchaser under M.G.L. c. 152 is responsible for the definition, authorization,
and approval of services.
(5)
Coding Updates and Corrections. EOHHS may publish
service code updates and corrections in the form of an administrative bulletin.
Updates may reference coding systems including, but not limited to, the
American Medical Association's Current Procedural Terminology
(CPT) and/or the Healthcare Common Procedure Coding System
(HCPCS). The publication of such updates and corrections will list:
(a) codes for which the code numbers change,
with the corresponding cross references between new codes and the code being
replaced. Rates for such new codes are set at the rate of the code that is
being replaced;
(b) codes for which
the code number remains the same, but the description has changed;
(c) deleted codes for which there are no
corresponding new codes; and
(d)
codes for entirely new services that require pricing. EOHHS will list these
codes and apply individual consideration (I.C.) payment for these codes until
appropriate rates can be developed.
(6)
Administrative
Bulletins. EOHHS may issue administrative bulletins to clarify its
policy on substantive provisions of
101 CMR
304.00 or to publish service code updates and
corrections. In addition, EOHHS may issue administrative bulletins that specify
the information and documentation necessary to implement
101 CMR
304.00.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.