Scope and Purpose
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.
Applicable Dates of
. Rates in
apply for dates of service provided on or after
January 1, 2023, unless otherwise indicated.
rates of payment under
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.
Disclaimer of Authorization
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.
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
and/or the Healthcare Common Procedure Coding System
. 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
(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
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.
. EOHHS may issue administrative bulletins to clarify its
policy on substantive provisions of
or to publish service code updates and
corrections. In addition, EOHHS may issue administrative bulletins that specify
the information and documentation necessary to implement
Register Issue 1351, eff.
Register Issue 1381, eff.
Register Issue 1385, eff.
Register Issue 1412, eff.
Register Issue 1459, eff.
Register Issue 1486, eff.