101 CMR, § 313.01 - General Provisions
(1)
Scope and Purpose. 101 CMR 313.00 governs the rates of
payment used by governmental units to pay eligible providers for abortion and
sterilization services provided to publicly aided individuals.
(2)
Applicable Dates of
Service. Rates contained in 101 CMR 313.00 apply for dates of
service provided on or after May 1, 2025, unless otherwise indicated.
(3)
Coverage. 101
CMR 313.00 and the rates of payment contained in 101 CMR 313.00 apply to
abortion and sterilization services rendered by eligible providers in an
ambulatory clinic setting. The rates of payment under 101 CMR 313.00 are full
compensation for all services rendered.
(4)
Disclaimer of Authorization
of Services. 101 CMR 313.00 is neither authorization for nor
approval of the substantive services for which rates are determined pursuant to
101 CMR 313.00. Governmental units that purchase services from eligible
providers are responsible for the definition, authorization, coverage policies,
and approval of the care and services extended to publicly aided
individuals.
(5)
Coding
Updates and Corrections. EOHHS may publish procedure 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 reference between new codes
and the codes 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 is no
corresponding new code; and
(d)
codes for entirely new services that require pricing. EOHHS will list these
codes and apply individual consideration (IC) reimbursement for these codes
until appropriate rates can be developed.
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.
(1) Scope, Purpose and Effective Date. 101 CMR 313.00 governs the rates of payment used by governmental units to pay eligible providers for abortion and sterilization services provided to publicly aided individuals.
(2) Applicable Dates of Service. Rates contained in 101 CMR 313.00 apply for dates of service provided on or after January 1, 2023, unless otherwise indicated.
(3) Coverage. 101 CMR 313.00 and the rates of payment contained in 101 CMR 313.00 apply to abortion and sterilization services rendered by eligible providers in an ambulatory clinic setting. The rates of payment under 101 CMR 313.00 are full compensation for all services rendered.
(4) Disclaimer of Authorization of Services. 101 CMR 313.00 is neither authorization for nor approval of the substantive services for which rates are determined pursuant to 101 CMR 313.00. Governmental units that purchase services from eligible providers are responsible for the definition, authorization, coverage policies, and approval of the care and services extended to publicly aided individuals.
(5) Coding Updates and Corrections. EOHHS may publish procedure 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 reference between new codes and the codes 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 is no corresponding new code; and
(d) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (I.C.) reimbursement for these codes until appropriate rates can be developed.