(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
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.
