101 C.M.R. 348.03 – Rate Provisions

(1) Rate as Full Payment. Each eligible provider must, as a condition of receipt of payment from one or more purchasing governmental units for services rendered, accept the approved rates as full payment and discharge of all obligations for the services rendered, subject only to appellate rights as set forth in M.G.L. c. 118E. There will be no duplication or supplementation of payment from sources other than those expressly recognized or anticipated in the computation of the rate. Any client resources or third-party payments received on behalf of a publicly assisted client will reduce, by that amount, the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.
(2) Approved Day Habilitation Program Rates. For services provided in day habilitation programs in the community, the approved rates include payment for all care and services that are customarily part of the program of services of an eligible provider, subject only to the terms of the purchase agreement between the eligible provider and the purchasing governmental unit(s). The rate of payment for authorized services is the lower of the established charge or the rate listed in 101 CMR 348.03(5).
(3) Day Habilitation Services in Nursing Facilities. Certain residents of nursing facilities who qualify for day habilitation services may be unable to participate in these services in community settings. These individuals may qualify for day habilitation services to be provided at the nursing facility in which they reside. In order to be eligible for these nursing facility services, the individual must meet criteria established by the MassHealth agency. These members will be billed at the Level 4 rate. The approved rates cover all care and services associated with the provision of day habilitation services in a nursing facility.
(4) Payment Level for Nursing Facility Residents in Community Day Habilitation Programs. Certain qualifying individuals in nursing facilities may need supplemental services in the form of additional staff assistance to enable them to leave their nursing facility to participate in day habilitation services in the community. The MassHealth agency will pay the Level 4 rate for those individuals so they may participate in a community day habilitation program.
(5) Allowable Fees. The rates of payment for authorized day habilitation program services, unless otherwise noted in 101 CMR 348.03, must be the lower of the established charge or the rate listed in 101 CMR 348.03(5). Refer to purchasers' manuals for special coding instructions and limitations on number of units.
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Final Adoption
Date Published in Mass. Register: August 2, 2024
101 CMR 348.00: RATES FOR DAY HABILITATION SERVICES

Code Per Diem Rate Description S5102-U1 $125.91 Skills training and development, per diem, Level 1(community

program)

S5102-U2 $167.85 Skills training and development per diem, Level 2 (community

program)

S5102-U3 $290.97 Skills training and development, per diem, Level 3 (community

program)

S5102-U4 $414.09 Skills training and development, per diem, Level 4 (community

program & nursing facility residents)

Code Half Per Diem Base Description

Rate

S5101-U1 $62.96 Skills training and development, half per diem , Level 1

(community program)

S5101-U2 $83.93 Skills training and development, half per diem, Level 2

(community program)

S5101-U3 $145.49 Skills training and development, half per diem, Level 3

(community program)

S5101-U4 $207.05 Skills training and development, half per diem, Level 4

(community program & nursing facility residents)

Code Quarter Per Description

Diem

S5100-U5- $31.48 Skills training and development, quarter per diem, Level 1(community U1 program) S5100-U5- $41.96 Skills training and development, quarter per diem, Level 2(community U2 program) S5100-U5- $72.74 Skills training and development, quarter per diem, Level 3 (community U3 program) S5100-U5- $103.52 Skills training and development, quarter per diem, Level 4 (community U4 program & nursing facility residents)

Code One-time Description

Only

S5105 $2000.00 Admission Services (one-time only on or after the 45th day of service) S5105-KZ $12,000.00 Re-engagement Services (one-time only on or after the 45th day of

service)

Code Per One-Way Trip Description T2003 $28.56 Non-wheelchair (ambulatory) transportation T2003-U6 $34.98 Wheelchair transportation (one-way trip) T2003-U7 $34.98 Monitor transportation (one-way trip)

Final Adoption

Date Published in Mass. Register: August 2, 2024

101 CMR 348.00: RATES FOR DAY HABILITATION SERVICES