101 CMR 347.01 - General Provisions
(1)
Scope and Purpose .
101 CMR 347.00 governs the
rates of payment to eligible freestanding ambulatory surgery centers (FASCs) to
be used by all governmental units for services provided to publicly aided
individuals. Rates for services provided to individuals covered by M.G.L. c.
152 (the Worker's Compensation Act), are not set forth in
101 CMR 347.00, but are at
114.3 CMR 40.00: Rates for Services under M.G.L. c. 152, Workers' Compensation
Act.
(2)
Applicable
Dates of Service . Rates contained in
101 CMR 347.00 apply for
dates of service provided on or after October 1, 2021, unless otherwise
indicated.
(3)
Coverage .
101 CMR 347.00 and the rates
of payment contained in
101 CMR 347.00 are full
compensation for facility services furnished in connection with surgical
procedures that can be performed safely on an ambulatory basis in an FASC, are
within the scope of covered services, and meet the purchasing governmental
unit's conditions of payment for such facility services. Payment from any other
sources will be used to offset the amount of the purchasing governmental unit's
obligation for such services rendered to publicly aided individuals.
101 CMR 347.00 does not
cover professional services that are billed by a physician, dentist, or
podiatrist separately from the surgery center and who receives no other
compensation for the professional services rendered. Covered freestanding
ambulatory surgery center services do not include services performed in a
hospital-based facility or medical, dental, or podiatric surgical procedures
that are customarily performed in an office setting.
(4)
Disclaimer of Authorization
of Services .
101 CMR 347.00 is not
authorization for or approval of the procedures for which rates are determined
pursuant to
101 CMR 347.00. Governmental
units that purchase care 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
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 (CPT). 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 codes being
replaced. Rates for such new codes are set at the rate of the code that is
being replaced;
(b) deleted codes
for which there are no corresponding new codes;
(c) 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,
unless 101 CMR 347.01(5)(d) is applied; and
(d) for entirely new codes that require new
pricing and that have Medicare rates, EOHHS may list these codes and price them
according to the rate methodology used in setting FASC facility component
rates.
(6)
Administrative Bulletins . EOHHS may issue
administrative bulletins to add, delete, or otherwise update codes or
modifiers, to clarify its policy on and understanding of substantive provisions
of
101 CMR 347.00, and
otherwise as specified in
101 CMR 347.00.
Notes
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