101 CMR, § 359.03 - Rate Provisions

(1) Services Included in the Rate. The approved rate will include payment for all care and services that are part of the program of services of a Provider, as explicitly set forth in the terms of the purchase agreement between the Provider and the purchasing governmental unit(s).
(2) Reimbursement as Full Payment. Each Provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment for services included in the scope of 101 CMR 359.00 from any other source must be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the participant.
(3) Payment Limitations.
(a) No purchasing governmental unit may pay less than or more than the approved program rate, except that a participant contribution may be applied towards the Residential Habilitation room and board payment in accordance with policies and procedures established by the purchasing governmental unit.
(b) Where more than one payment rate is available for a covered service, the service is covered at the lowest available payment rate, unless a higher rate is approved by the purchasing governmental unit, except as provided in 101 CMR 359.03(3)(c).
(c) Notwithstanding the requirement of 101 CMR 359.03(3)(b), payment rates for certain HCBS waiver services will be determined as follows:
1. Residential Habilitation rates will be determined in the following manner:
a. Service Model Rate. The purchasing Governmental Unit will designate the applicable rate from among the basic lower intensity, basic, or Intermediate categories, or at medical/clinical level 1, medical/clinical level 2, or medical/clinical level 3 as outlined and defined in 101 CMR 420.00: Rates for Adult Long-term Residential Services.
b. Room and Board. The purchasing Governmental Unit will designate the applicable rate for room and board from among the site rates outlined in 101 CMR 420.00: Rates for Adult Long-term Residential Services.
2. Orientation and Mobility. Orientation and Mobility rates will be determined: based on one-way distance traveled to initiate the service in the following manner:
a. Level I: one to 30 miles;
b. Level II: 31 to 60 miles; and
c. Level III: over 60 miles.
3. Shared Home Supports. The purchasing Governmental Unit will designate the applicable stipend rate at level 1, 2 or 3, as outlined and defined in 101 CMR 411.00: Rates for Certain Placement, Support, and Shared Living Services.
4. Shared Living - 24 Hour Supports. Shared Living - 24-hour support rates will be determined in the following manner
a. Operational Rate: The purchasing Governmental Unit will designate the applicable rate from among the available operational rate levels as outlined and defined in 101 CMR 411.00: Rates for Certain Placement, Support, and Shared Living Services.
b. Stipend Rate: The purchasing Governmental Unit will designate the applicable rate from among the available Stipend Levels, corresponding to the designated operational rate Level as outlined and defined in 101 CMR 411.00: Rates for Certain Placement, Support, and Shared Living Services.
(4) Approved Rates. The approved rate will be the lowest of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 359.03(4).

Service

HCBS Waiver

Units

Agency Rate

Non-agency Rate

Individual Provider (Self-employed Provider)

Self-directed Service

Adult Companion

ABI-N, MFP-CL

Per 15 Min.

$6.50

89.75% of Agency Rate

89.75% of Agency Rate

Assisted Living

ABI-RH, MFP-RS

Per Diem

$112.02

N/A

N/A

Assistive Technology - devices

ABI-N, ABI-RH, MFP-CL, MFP-RS

Per Device

I.C.

N/A

N/A

Assistive Technology - evaluation and training

ABI-N, ABI-RH, MFP-CL, MFP-RS

Per 15 Min.

See 101 CMR 423.00 Rates for Certain In-Home Basic Living Supports

Chore

ABI-N, MFP-CL

Per 15 Min.

$10.13

89.75% of Agency Rate

89.75% of Agency Rate

Community-based Day Supports

ABI-N, ABI-RH, MFP-CL, MFP-RS

Per 15 Min.

See101 CMR 415.00: Rates for Community based Day Support Services; Levels A, B, C, & I

N/A

N/A

Community Support and Navigation

ABI-N, ABI-RH, MFP-CL, MFP-RS

Per 15 Min.

See101 CMR 444.00: Rates for Certain Substance Use Disorder Services: Recovery Support Navigator Service

N/A

N/A

Community Family Training

ABI-N, MFP-CL

Per 15 Min.

See101 CMR 414.00: Rates for Family Stabilization Services (Family Training rate divided by 4 to determine rate per 15-minute increments)

89.75% of Agency Rate

N/A

Day Services

ABI-N, ABI-RH, MFP-CL, MFP-RS

Per Diem,

Per Diem: $115.72

N/A

N/A

Day Services - partial per diem

ABI-N, ABI-RH, MFP-CL, MFP-RS

Partial Per Diem

Partial Per Diem: $57.86

N/A

N/A

Home Accessibility Adaptations

ABI-N, ABI-RH MFP-CL, MFP-RS

Item

I.C.

N/A

N/A

Home Delivered Meals

ABI-N, MFP-CL

Meal

$10

N/A

N/A

Home Health Aide

ABI-N, MFP-CL

Per 15 Min.

See101 CMR 350.00: Home Health Services

N/A

N/A

Homemaker

ABI-N, MFP-CL

Per 15 Min.

$8.22

89.75% of Agency Rate

89.75% of Agency Rate

Independent Living Supports

ABI-N, MFP-CL

Per Diem

$88.02

N/A

N/A

Individual Support and Community Habilitation

ABI-N, ABI-RH, MFP-CL, MFP-RS

Per 15 Min.

See101 CMR 423.00: Rates for Certain Inhome Basic Living Sup-ports; Levels G-H & I

89.69% of Agency Rate

89.69% of Agency Rate

Laundry

ABI-N, MFP-CL

Per Order

$30.17

N/A

N/A

Occupational Therapy

ABI-N, ABI-RH, MFP-CL, MFP-RS

Per Visit

See101 CMR 350.00: Home Health Services

See101 CMR 339.00: Restorative Services (out-of-office visit rate)

N/A

Orientation and Mobility Services

MFP-CL, MFP-RS

Per 15 Min

Level I: $33.58

Level II: $37.12

Level III: $40.66

Level I: $33.58

Level II: $37.12

Level III: $40.66

N/A

Peer Support

ABI-N, ABI-RH, MFP-CL, MFP-RS

Per 15 Min.

See101 CMR 414.00: Rates for Family Stabilization Services (rate divided by 4 to determine rate per 15-minute increments)

89.75% of Agency Rate

89.75% of Agency Rate

Personal Care

ABI-N, MFP-CL

Per 15 Min.

$8.22

See101 CMR 309.00: Rates for Certain Services for the Personal Care Attendant Program

See101 CMR 309.00: Rates for Certain Services for the Personal Care Attendant Program

Physical Therapy

ABI-N, ABI-RH, MFP-CL, MFP-RS

Per Visit

See101 CMR 350.00: Home Health Services

See101 CMR 339.00: Restorative Services (out-of-office visit rate)

N/A

Prevocational Services

ABI-N, ABI-RH, MFP-CL, MFP- RS

Per 15 Min.

See101 CMR 419.00: Rates for Supported Employment Services (rate for Individual Supported Employment)

N/A

N/A

Residential Family Training

ABI-RH, MFP-RS

Per 15 Min.

See101 CMR 414.00: Rates for Family Stabilization Services (Family Training rate divided by 4 to determine rate per 15-minute increments)

89.75% of Agency Rate

N/A

Residential Habilitation Room and Board

ABI-RH, MFP-RS

Per Diem

See101 CMR 420.00: Rates for Adult Long-term Residential Services (Site Rates)

N/A

N/A

Residential Habilitation Services

ABI-RH, MFP-RS

Per Diem

See101 CMR 420.00:

Rates for Adult Long-term Residential Services (Basic Lower Intensity, Basic, or Intermediate categories, Medical/Clinical Level 1, Medical/Clinical Level 2, or Medical/Clinical Level 3

N/A

N/A

Respite

ABI-N, MFP-CL

Per Diem

I.C.

N/A

N/A

Shared Home Supports

ABI-N, MFP-CL

Per Diem

See101 CMR 411.00: Rates for Certain Placement, Support, and Shared Living Services (Operational Rate Level A, Stipend Levels 1, 2, or 3)

N/A

N/A

Shared Living - 24 Hour Supports

ABI-RH, MFP-RS

Per Diem

See101 CMR 411.00:

Rates for Certain Placement, Support, and Shared Living Services

N/A

N/A

Skilled Nursing - LPN

ABI-N, ABI-RH, MFP-CL, MFP-RS

Per Visit

See101 CMR 350.00: Home Health Services (Rates for Skilled Nursing Services)

N/A

N/A

Skilled Nursing - RN

ABI-N, ABI-RH, MFP-CL, MFP-RS

Per Visit

See101 CMR 350.00: Home Health Services (Rates for Skilled Nursing Services)

N/A

N/A

Specialized Medical Equipment

ABI-N, ABI-RH, MFP-CL, MFP-RS

Item

See101 CMR 322.00: Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment

See101 CMR 322.00: Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment

N/A

Speech Therapy

ABI-N, ABI-RH, MFP-CL, MFP-RS

Per Visit

See101 CMR 350.00: Home Health Services

See101 CMR 339.00: Restorative Services (out-of-office visit rate)

N/A

Supported Employment

ABI-N, ABI-RH, MFP-CL, MFP-RS

Per 15 Min.

See101 CMR 419.00: Rates for Supported Employment Services (rate for Individual Supported Employment)

N/A

N/A

Supportive Home Care Aide

ABI-N, MFP-CL

Per 15 Min.

See101 CMR 350.00: Home Health Services (13.12% above the rate for Home Health Aide)

N/A

N/A

Transitional Assistance

ABI-N, ABI-RH, MFP-CL, MFP-RS

Per Episode

I.C.

N/A

N/A

Transportation

ABI-N, ABI-RH, MFP-CL, MFP-RS

One-way Trip

See101 CMR 327.00: Rates of Payment for Ambulance and Wheelchair Van Services

N/A

N/A

Vehicle Modification

ABI-N, MFP-CL

Item

I.C.

N/A

N/A
(5) Self-directed Service Rates.
(a) Employer Expense Component. The rates for Self-directed Services consists of two components: the Self-directed Worker rate and the Employer Expense Component (EEC).

Service

Unit

Self-directed Worker Rate

Employer Expense Component

Self-directed Service Rate

Adult Companion

Per 15 Min.

$5.23

$0.60

$5.83

Chore

Per 15 Min.

$8.16

$0.93

$9.09

Homemaker

Per 15 Min.

$6.63

$0.75

$7.38

Individual Supports and Community Habilitation: Level G

Per 15 Min.

$9.32

$1.06

$10.38

Individual Supports and Community Habilitation: Level H

Per 15 Min.

$10.04

$1.14

$11.18

Individual Supports and Community Habilitation: Level I

Per 15 Min.

$12.27

$1.40

$13.67

Peer Support

Per 15 Min.

$6.32

$0.72

$7.04

Personal Care

Per 15 Min.

See101 CMR 309.00: Rates for Certain Services for the Personal Care Attendant Program (rate divided by four to determine rate per 15-minute increments)
(b) Overtime Calculation. Overtime payments for self-directed services will be made in accordance with the federal Fair Labor Standards Act. Such payments will be made to self-directed workers at rate of one and a half times that of the rate for the service or services provided. For self-directed workers that provide services paid at different rates, such overtime rate will consist of the blended weighted rate based on the number of hours for which each service was provided during a single work week. For the purposes of 101 CMR 359.03(5)(b), the term overtime will mean self-directed services provided to one or more participants in excess of 40 hours per work week, where work week consists of a seven-day period beginning Sunday at 12:00 A.M. and ending the consecutive Saturday at 11:59 P.M.
(6) Approved Modifiers. Below are the approved modifiers for all four HCBS Waiver programs:
(a) Modifier Classification. Below are the classification descriptions for modifiers associated with both the ABI and MFP Waivers.

Modifier

Description

U1

Agency Provider

U2

Individual/Self-employed Provider

U4

ABI Nonresidential Habitation (ABI-N) Waiver

U5

ABI Residential Habitation (ABI-RH) Waiver

U8

MFP Community Living (MFP-CL) Waiver

U9

MFP Residential Supports (MFP-RS) Waiver

UB

Self-directed Service
(b) Service Codes and Modifiers by Service. The list of approved service codes and modifiers for all four ABI and MFP Waivers are as follows.

Service

Agency

Individual Provider (Self-employed Provider)

Self-directed Service

Code

1st Position Modifier

2nd Position Modifier

Code

1st Position Modifier

2nd Position Modifier

Code

1st Position Modifier

2nd Position Modifier

Adult Companion

-

-

-

S5125

U4

-

S5125

U4

UB

-

-

-

S5125

U8

-

S5125

U8

UB

S5135

U4

-

-

-

-

-

-

-

S5135

U8

-

-

-

-

-

-

-

Assisted Living

T2031

U5

-

-

-

-

-

-

-

T2031

U9

-

-

-

-

-

-

-

Assistive Technology -devices

T2029

U4

-

-

-

-

-

-

T2029

U5

-

-

-

-

-

-

T2029

U8

-

-

-

-

-

-

T2029

U9

-

-

-

-

-

-

Assistive Technology -evaluation and training

97755

U4

97755

U5

97755

U8

97755

U9

Chore Services

S5120

U4

U1

S5120

U4

U2

S5120

U4

UB

S5120

U8

U1

S5120

U8

U2

S5120

U8

UB

Community-based Day Supports

S5100

U4

-

-

-

-

-

-

S5100

U4

U1

-

-

-

-

-

S5100

U4

U2

S5100

U4

U3

S5100

U5

-

-

-

-

-

-

-

S5100

U5

U1

-

-

-

-

-

-

S5100

U5

U2

-

-

-

-

-

-

S5100

U5

U3

-

-

-

-

-

-

S5100

U8

-

-

-

-

-

-

-

S5100

U8

U1

-

-

-

-

-

-

S5100

U8

U2

-

-

-

-

-

-

S5100

U8

U3

-

-

-

-

-

-

S5100

U9

-

-

-

-

-

-

-

S5100

U9

U1

-

-

-

-

-

-

S5100

U9

U2

-

-

-

-

-

-

S5100

U9

U3

-

-

-

-

-

-

Community Support and Navigation

H2015

U4

-

-

-

-

-

-

-

H2015

U5

-

-

-

-

-

-

-

H2015

U8

-

-

-

-

-

-

-

H2015

U9

-

-

-

-

-

-

-

Community Family Training

S5110

U4

U1

S5110

U4

U2

S5110

U8

U1

S5110

U8

U2

-

-

-

Day Services

S5102

U4

-

-

-

-

-

-

S5102

U5

-

-

-

-

-

-

-

S5102

U8

-

-

-

-

-

-

-

S5102

U9

-

-

-

-

-

-

-

Day Services -partial per diem

S5102

U4

S5102

U5

S5102

U8

-

S5102

U9

-

Home Accessibility Adaptations

S5165

U4

-

-

-

-

-

S5165

U5

-

-

-

-

-

S5165

U8

-

S5165

U8

S5165

U9

-

S5165

U9

-

-

-

-

Home Delivered

Meals

S5170

U4

-

-

-

-

-

-

-

S5170

U8

Homemaker

S5130

U4

U1

S5130

U4

U2

S5130

U4

UB

S5130

U8

U1

S5130

U8

U2

S5130

U8

UB

Home Health Aide

G0156

U4

G0156

U8

-

-

-

-

-

-

-

Independent Living Supports

H0043

U4

H0043

U8

-

-

-

-

-

-

-

Individual Support and Community Habilitation (Individual Provider/Self-directed Worker)

-

-

-

H2014

U4

U1, U2, U3

H2014

U4

U1, UB

U2, UB

U3, UB

-

-

-

H2014

U8

U1, U2, U3

H2014

U8

U1, UB

U2, UB

U3, UB

H2014

U9

U1, U2, U3

H2014

U9

-

Individual Support and Community Habilitation (Agency)

S5108

U4

U1, U2, U3

-

-

-

-

-

-

S5108

U8

U1, U2, U3

-

-

-

-

-

-

S5108

U9

U1, U2, U3

-

-

-

-

-

-

Laundry

S5175

U4

-

-

-

-

-

-

-

S5175

U8

-

Occupational Therapy

S9129

U4

U1

S9129

U4

U2

-

-

-

S9129

U5

U1

S9129

U5

U2

-

-

-

S9129

U8

U1

S9129

U8

U2

-

-

-

S9129

U9

U1

S9129

U9

U2

-

-

-

Orientation and Mobility Services

H2021

U4

U1, U2, U3

H2021

U4

U1, U2, U3

H2021

U5

U1, U2, U3

H2021

U5

U1, U2, U3

H2021

U8

U1, U2, U3

H2021

U8

U1, U2, U3

-

-

-

H2021

U9

U1, U2, U3

H2021

U9

U1, U2, U3

-

-

-

Peer Support

H0038

U4

U1

H0038

U4

U2

H0038

U4

UB

H0038

U5

U1

H0038

U5

U2

H0038

U5

UB

H0038

U8

U1

H0038

U8

U2

H0038

U8

UB

H0038

U9

U1

H0038

U9

U2

H0038

U9

UB

Personal Care

T1019

U4

-

-

-

-

-

-

-

T1019

U8

U1

T1019

U8

U2

T1019

U8

UB

Physical Therapy

S9131

U4

U1

S9131

U4

U2

-

-

-

S9131

U5

U1

S9131

U5

U2

-

-

-

S9131

U8

U1

S9131

U8

U2

-

-

-

S9131

U9

U1

S9131

U9

U2

-

-

-

Prevocational Services

T2019

U4

T2019

U5

-

-

-

-

-

-

-

T2019

U8

-

-

-

-

-

-

-

T2019

U9

-

-

-

-

-

-

-

Residential Family Training

S5110

U5

U1

S5110

U5

U2

S5110

U9

U1

S5110

U9

U2

-

-

-

Residential Habilitation

T2016

U5

-

-

-

-

-

-

-

T2016

U9

-

-

-

-

-

-

-

Respite

H0045

U4

-

-

-

-

-

-

-

H0045

U8

-

-

-

-

-

-

-

Shared Home Supports

H2016

U4

U1

H2016

U4

U2

H2016

U4

U3

H2016

U8

U1-

-

-

-

-

-

-

H2016

U8

U2

-

-

-

-

-

-

H2016

U8

U3

-

-

-

-

-

-

Shared Living -24-hour Supports

T2033

U5

-

-

-

-

-

-

-

T2033

U9

-

-

-

-

-

-

-

Skilled Nursing - RN

G0299

U4

G0299

U5

G0299

U8

-

-

-

-

-

-

-

G0299

U9

-

-

-

-

-

-

-

Skilled Nursing - LPN

G0300

U4

G0300

U5

G0300

U8

-

-

-

-

-

-

-

G0300

U9

-

-

-

-

-

-

-

Specialized Medical Equipment

T2029

U4

-

T2029

U4

-

-

-

-

T2029

U5

-

T2029

U4

-

-

-

-

T2029

U8

-

-

-

-

-

-

-

T2029

U9

-

-

-

-

-

-

-

Speech Therapy

S9128

U4

U1

S9128

U4

U2

-

-

-

S9128

U5

U1

S9128

U5

U2

-

-

-

S9128

U8

U1

S9128

U8

U2

-

-

-

S9128

U9

U1

S9128

U9

U2

-

-

-

Supported Employment

H2023

U4

-

-

-

-

-

-

-

H2023

U5

-

-

-

-

-

-

-

H2023

U8

-

-

-

-

-

-

-

H2023

U9

-

-

-

-

-

-

-

Supportive Home Care Aide

T1004

U4

T1004

U8

-

-

-

-

-

-

-

Transportation

T2003

U4

-

-

-

-

-

-

-

T2003

U5

-

-

-

-

-

-

-

T2003

U8

-

-

-

-

-

-

-

T2003

U9

-

-

-

-

-

-

-

Transitional Assistance

T2038

U4

-

-

-

-

-

-

-

T2038

U5

-

-

-

-

-

-

-

T2038

U8

-

-

-

-

-

-

-

T2038

U9

-

-

-

-

-

-

-

Vehicle Modification

T2039

U4

T2039

U8

-

-

-

-

-

-

-

Notes

101 CMR, § 359.03
Adopted by Mass Register Issue S1331, eff. 1/27/2017. Amended by Mass Register Issue 1335, eff. 1/27/2017. Amended by Mass Register Issue 1424, eff. 8/21/2020. Amended by Mass Register Issue 1428, eff. 8/21/2020. Amended by Mass Register Issue 1437, eff. 1/29/2021. Amended by Mass Register Issue 1442, eff. 1/29/2021. Amended by Mass Register Issue 1499, eff. 7/7/2023. Amended by Mass Register Issue 1505, eff. 7/7/2023.

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