101 CMR 419.03 - Rate Provisions

(1) Services Included in the Rate. The approved rate includes 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 from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.
(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate except as authorized by 101 CMR 419.03(2).
(4) Administrative Adjustment for Extraordinary Circumstances. A method whereby, subject to availability of funds, a purchasing governmental unit may provide additional resource allocations to a qualified provider in response to unusual and unforeseen circumstances that substantially increase the cost of service delivery in ways not contemplated in the development of current rates. It must be demonstrated that such cost increases gravely threaten the stability of service provision such that client or consumer access to necessary services is at risk. The purchasing governmental unit will evaluate the need for the administrative adjustment, determine whether funding is available, and convey that information to EOHHS for review to determine the amount of any adjustment.
(5) Approved Rates. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 419.03(5). Providers must bill for services in 15-minute units.

Base Service

Rate (15 mins) per Client

Individual Supported Employment ($65.48 hourly)

$16.37

Ongoing Individual Supported Employment ($48.36 hourly)

$12.09

Group Supported Employment ($23.52 hourly)

$5.88

High-intensity Service/Specialized Program Rates

Rate (15 mins) per Client

High-intensity Group Supported Employment ($30.96 hourly) $7.74

Add-on Services

Rate (15 mins) per Client

Direct Care ($26.08 hourly)

$6.52

Direct Care III ($33.28 hourly)

$8.32

Transportation to Individual Job Sites

Rate (15 mins) per Client

Travel to and from ISE job sites up to one hour ($36.12 hourly) $9.03

Enhanced Staffing for Higher Intensity Clients (Combined Add-on and Base Service Rates)

Rate (15 mins) per Client

1:1 Group Supported Employment ($49.04 hourly)

$12.26

1:3 Group Supported Employment ($32.04 hourly)

$8.01

Notes

101 CMR 419.03
Amended by Mass Register Issue 1306, eff. 2/12/2016. Amended by Mass Register Issue 1351, eff. 11/3/2017. Amended by Mass Register Issue 1394, eff. 6/28/2019. Amended by Mass Register Issue 1447, eff. 7/9/2021. Amended by Mass Register Issue 1459, eff. 1/1/2022. Amended by Mass Register Issue 1505, eff. 9/29/2023.

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