Services Included in the Rate. The approved rate
includes payment for all care and services that are part of the program of
services of an eligible provider, as explicitly set forth in the terms of the
purchase agreement between the eligible provider and the purchasing
Reimbursement as Full Payment. Each eligible 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
Payment Limitations. No purchasing governmental unit
may pay less than or more than the approved program rate.
Administrative Adjustment for
Extraordinary Circumstances. A provider may petition the
purchasing governmental unit for an administrative adjustment to reflect
increases in operating costs due to unusual and unforeseen circumstances or
extraordinary client service requirements not considered in the development of
the current rates. Unusual and unforeseen circumstances are events of
catastrophic nature (e.g., fire, flood, or earthquake) that
are not covered by insurance that the prudent provider would carry. The
provider must demonstrate 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
. 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 425.03
Register Issue 1317, eff.
Register Issue S1360, eff.
Register Issue 1419, eff.
Register Issue 1472, eff.