101 CMR, § 309.01 - General Provisions
(1)
Scope and Purpose. 101 CMR 309.00 governs the rates of
payment to be used by all governmental units for the personal care attendant
(PCA) program. 101 CMR 309.00 also governs payments for PCA services provided
to individuals covered by M.G.L. c. 152 (the Worker's Compensation Act). Rates
for transitional living program services are approved under 114.5 CMR 4.00:
Rates for Certain Social, Rehabilitation and Health Care
Services.
(2)
Applicable Dates of Service. Rates contained in 101
CMR 309.00 apply for dates of service described in
101
CMR 309.03.
(3)
Coverage. The
payment rates established by 101 CMR 309.00 apply to certain services for the
PCA program provided by eligible PCA providers and personal care management
(PCM) agencies to enable publicly aided persons with permanent or chronic
disabilities to live independently in the community. The payment rates
established by 101 CMR 309.00 are full compensation for services rendered and
for certain related administrative or supervisory duties rendered in the
provision of services.
(4)
Disclaimer of Authorization of Services. 101 CMR
309.00 is not authorization for or approval of the services for which rates are
established by 101 CMR 309.00. Governmental units that purchase PCA services
are responsible for the definition, authorization, and approval of care and
services extended to publicly aided individuals.
(5)
Coding Updates and
Corrections. EOHHS may publish service code updates and
corrections by administrative bulletin. Updates may reference coding systems
including, but not limited to, the American Medical Association's Current
Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System
(HCPCS) maintained by the Centers for Medicare & Medicaid Services (CMS).
The publication of such updates and corrections will list
(a) codes for which only the code numbers
change, with the corresponding cross-references between existing and new
codes;
(b) deleted codes for which
there are no corresponding new codes; and
(c) codes for entirely new services that
require pricing. These codes will be paid on an individual consideration basis
until rates are established.
Notes
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