Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 313.00 - Rates For Freestanding Clinics Providing Abortion And Sterilization Services
Section 313.01 - General Provisions

Universal Citation: 101 MA Code of Regs 101.313

Current through Register 1518, March 29, 2024

(1) Scope, Purpose and Effective Date. 101 CMR 313.00 governs the rates of payment used by governmental units to pay eligible providers for abortion and sterilization services provided to publicly aided individuals.

(2) Applicable Dates of Service. Rates contained in 101 CMR 313.00 apply for dates of service provided on or after January 1, 2023, unless otherwise indicated.

(3) Coverage. 101 CMR 313.00 and the rates of payment contained in 101 CMR 313.00 apply to abortion and sterilization services rendered by eligible providers in an ambulatory clinic setting. The rates of payment under 101 CMR 313.00 are full compensation for all services rendered.

(4) Disclaimer of Authorization of Services. 101 CMR 313.00 is neither authorization for nor approval of the substantive services for which rates are determined pursuant to 101 CMR 313.00. Governmental units that purchase services from eligible providers are responsible for the definition, authorization, coverage policies, and approval of the care and services extended to publicly aided individuals.

(5) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association's Current Procedural Terminology (CPT) and/or the Healthcare Common Procedure Coding System (HCPCS). The publication of such updates and corrections will list:

(a) codes for which the code numbers change, with the corresponding cross reference between new codes and the codes being replaced. Rates for such new codes are set at the rate of the code that is being replaced;

(b) codes for which the code number remains the same, but the description has changed;

(c) deleted codes for which there is no corresponding new code; and

(d) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (I.C.) reimbursement for these codes until appropriate rates can be developed.

(6) Administrative Bulletins. EOHHS may issue administrative bulletins to add, delete, or otherwise update codes or modifiers, to clarify its policy on and understanding of substantive provisions of 101 CMR 313.00, and as otherwise specified in 101 CMR 313.00.

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