Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 329.00 - Rates for Psychological and Independent Clinical Social Work Services
Section 329.03 - General Rate Provisions

Universal Citation: 101 MA Code of Regs 101.329

Current through Register 1531, September 27, 2024

(1) General Rate Provisions. The rates of payment for psychological and licensed independent clinical social work services to which 101 CMR 329.00 applies are the lower of:

(a) The eligible provider's usual charge to the general public for the same or similar services; or

(b) The schedule of allowable fees listed in 101 CMR 329.04 and 329.05.

(2) Rates as Full Compensation. The rates of payment contained in 101 CMR 329.00 constitute full compensation for psychological and licensed independent clinical social work services provided by eligible providers to publicly aided individuals, including full compensation for necessary administration (including, but not limited to, interviewing, testing, scoring, interpreting, and writing of reports) and professional supervision associated with patient care.

(3) Individual Consideration.

(a) Rates of payment to eligible providers for services authorized in 101 CMR 329.00 but not listed herein or for authorized services performed in exceptional circumstances are determined on an Individual Consideration (I.C.) basis by the governmental unit purchaser upon receipt of a report that describes the services rendered. Degree of skill and/or expertise and extension of time, associated with the accommodation of functional limitations of publicly aided individuals with disabilities will be considered for I.C. and must be adequately documented to support the appropriateness of such claims.

(b) Hours. The determination of the number of hours of services purchased for authorized I.C. procedures is in accordance with the following criteria:
1. Time required to perform the service;

2. Severity or complexity of the client's disorder or disability;

3. Prevailing professional ethics and accepted practice;

4. Such other standards and criteria as may be adopted from time to time by EOHHS or the governmental purchaser.

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