101 CMR 352.03 - Rate Provisions

(1) Rates as Full Compensation. The rates under 101 CMR 352.03 constitute full compensation for children's behavioral health services provided by community service agencies to publicly aided patients, including full compensation for necessary administration and professional supervision associated with patient care.

(2) Rates of Payment. Payment rates under 101 CMR 352.03 are the lowest of

(a) the eligible provider's usual charge to the general public;

(b) the amount accepted as payment from another payer; or

(c) the schedule of allowable rates for services as set forth in 101 CMR 352.03(3).

(3) Fee Schedule.

(a) Unit of service is per 15 minutes, unless otherwise indicated. Allowable fee for dates of service on or after August 1, 2023.

H0038	$24.69	Self-help/peer services, per 15 minutes (parent-caregiver peer-to-peer support service provided by a family partner)
H2011-HN	$30.57	Crisis intervention service, per 15 minutes (mobile crisis intervention service provided by a paraprofessional, hospital emergency department)
H2011-HO	$39.70	Crisis intervention service, per 15 minutes (mobile crisis intervention service provided by a master-level clinician, hospital emergency department.)
H2014-HN	$20.15	Skills training and development, per 15 minutes (behavior management monitoring provided by a bachelor-level clinician)
H2014-HO	$33.86	Skills training and development, per 15 minutes (behavior management therapy provided by a master-level clinician)
H2019-HN	$22.67	Therapeutic behavioral services, per 15 minutes (therapeutic training and support services provided by a bachelor-level clinician)
H2019-HO	$32.33	Therapeutic behavioral services, each 15 minutes (in-home therapy provided by a master-level clinician)
T1027-EP	$23.24	Family training and counseling for child development, per 15 minutes (therapeutic mentoring service)
H0023-HT	$66.99	Behavioral Health Outreach Service (Targeted Case Management (multi-disciplinary team) that includes family support and training and intensive care coordination per day)

(b) For mobile crisis intervention services at community-based sites of service, refer to 101 CMR 305.00: Rates for Behavioral Health Services Provided in Community Behavioral Health Centers.

(4) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. The publication of such updates and corrections will list

(a) codes for which only the code numbers changed, with the corresponding cross-walk;

(b) codes for which the code number remains the same but the description has changed; and

(c) deleted codes for which there is no cross-walk. In addition, for entirely new codes that require new pricing, EOHHS will list these codes and apply individual consideration in reimbursing these new codes until rates are established.

(5) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on, and understanding of, substantive provisions of 101 CMR 352.00.

(6) Billing. Each eligible provider must bill the governmental unit according to the appropriate fee schedule on a prescribed form. Each specific service must be separately enumerated on the bill.

Notes

101 CMR 352.03

Amended by Mass Register Issue 1303, eff. 7/1/2015. Amended by Mass Register Issue 1317, eff. 1/4/2016. Amended by Mass Register Issue 1376, eff. 10/19/2018. Amended by Mass Register Issue 1433, eff. 12/25/2020. Amended by Mass Register Issue 1459, eff. 12/24/2021. Amended by Mass Register Issue 1470, eff. 12/24/2021. Amended by Mass Register Issue 1487, eff. 1/1/2023 (EMERGENCY). Amended by Mass Register Issue 1493, eff. 1/1/2023 (EMERGENCY). Amended by Mass Register Issue 1496, eff. 1/1/2023 (COMPLIANCE). Amended by Mass Register Issue 1501, eff. 8/1/2023 (EMERGENCY). Amended by Mass Register Issue 1508, eff. 8/1/2023 (EMERGENCY). Amended by Mass Register Issue 1511, eff. 8/1/2023 (EMERGENCY). Amended by Mass Register Issue 1512, eff. 8/1/2023 (COMPLIANCE).