101 CMR, § 329.03 - General Rate Provisions
(1)
General Rate Provisions. The rates of payment for
psychological and licensed independent behavioral health clinician services to
which 101 CMR 329.00 applies are the lower of:
(a) The eligible provider's usual charge to
the general public for the same or similar services; or
(2)
Rates as Full
Compensation. The rates of payment contained in 101 CMR 329.00
constitute full compensation for psychological and licensed independent
behavioral health clinician services provided by eligible providers to publicly
aided individuals, including full compensation for necessary administration
(including, but not limited to, interviewing, testing, scoring, interpreting,
and writing of reports) and professional supervision associated with patient
care.
(3)
Individual
Consideration.
(a) Rates of
payment to eligible providers for services authorized in 101 CMR 329.00 but not
listed herein or for authorized services performed in exceptional circumstances
are determined on an Individual Consideration (IC) basis by the governmental
unit purchaser upon receipt of a report that describes the services rendered.
Degree of skill and/or expertise and extension of time, associated with the
accommodation of functional limitations of publicly aided individuals with
disabilities will be considered for IC and must be adequately documented to
support the appropriateness of such claims.
(b)
Hours. The
determination of the number of hours of services purchased for authorized IC
procedures is in accordance with the following criteria:
1. time required to perform the
service;
2. severity or complexity
of the client's disorder or disability;
3. prevailing professional ethics and
accepted practice; and
4. such
other standards and criteria as may be adopted occasionally by EOHHS or the
governmental purchaser.
(4)
Modifiers.
(a) -AH: Clinical psychologist (This modifier
is to be applied to service codes billed by the mental health center that were
performed by doctoral level clinician, including PhD, PsyD, or EdD);
(b) -HO: Master's degree level (This modifier
is to be applied to service codes billed by the mental health center that were
performed by LMHCs, LMFTs, or LICSWs;
(c) -HA: Child/adolescent program (This
modifier is to be applied to service codes billed when performed with a
Children and Adolescent Needs and Strengths (CANS)).
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) General Rate Provisions. The rates of payment for psychological and licensed independent clinical social work services to which 101 CMR 329.00 applies are the lower of:
(a) The eligible provider 's usual charge to the general public for the same or similar services; or
(2) Rates as Full Compensation. The rates of payment contained in 101 CMR 329.00 constitute full compensation for psychological and licensed independent clinical social work services provided by eligible providers to publicly aided individuals, including full compensation for necessary administration (including, but not limited to, interviewing, testing, scoring, interpreting, and writing of reports) and professional supervision associated with patient care.
(3) Individual Consideration.
(a) Rates of payment to eligible providers for services authorized in 101 CMR 329.00 but not listed herein or for authorized services performed in exceptional circumstances are determined on an Individual Consideration (I.C.) basis by the governmental unit purchaser upon receipt of a report that describes the services rendered. Degree of skill and/or expertise and extension of time, associated with the accommodation of functional limitations of publicly aided individuals with disabilities will be considered for I.C. and must be adequately documented to support the appropriateness of such claims.
(b) Hours. The determination of the number of hours of services purchased for authorized I.C. procedures is in accordance with the following criteria:
1. Time required to perform the service;
2. Severity or complexity of the client's disorder or disability;
3. Prevailing professional ethics and accepted practice;
4. Such other standards and criteria as may be adopted from time to time by EOHHS or the governmental purchaser.