. Rates of payment for authorized community health
center services to which
applies are the lower of
(a) the community health center's usual
charge to the general public (other than publicly aided individuals or
industrial accident patients) for the same or similar services; or
the schedule of allowable fees set forth
in 101 CMR 304.04
. Non-listed procedures and services
designated I.C. are individually considered items. The community health
center's bill for such an item must be accompanied by a brief report of the
procedure or service provided, including a pertinent history and diagnosis, a
description of the service rendered, and the length of time spent with the
patient. In making the determination of whether the service is appropriately
classified as an individually considered item, the purchasing agency uses the
(a) policies, procedures,
and practices of other third-party purchasers of care, both governmental and
(b) the severity and
complexity of the patient's disorder or disability;
(c) prevailing provider ethics and accepted
(d) time, degree of
skill, and cost, including equipment cost required to perform the
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