Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 343.00 - Rates for Hospice Services
Section 343.04 - General Rate Provisions
Current through Register 1531, September 27, 2024
(1) Effect of 101 CMR 343.00. The rates of payment under 101 CMR 343.00 constitute full compensation for hospice services provided to publicly aided individuals, including necessary administration and professional supervision. These established rates of payment for authorized services, with the exception of payment for room and board, will be set in accordance with Centers for Medicare & Medicaid Services (CMS) regulation at 42 CFR 418.302.
(2) Rate Determination. Each payment rate is determined by CMS to reflect the cost incurred by a hospice in efficiently providing the core and supplemental services associated with that type of hospice care to Medicaid beneficiaries. The allowable Medicaid hospice rates are determined in accordance with 42 CFR 418.302. The Medicaid rates are determined by adding the unweighted amount to the wage component, as adjusted to reflect local differences in wages, in accordance with 42 CFR 418.306.
(3) Rates. Allowable rates for hospice services are outlined in 101 CMR 343.04(3)(a) and (b).
Barnstable |
Compliant Rate |
Noncompliant Rate |
||
T2042 |
Routine Home Care (one-60 days) |
Per Diem |
$237.32 |
$228.12 |
T2042 UD |
Routine Home Care (61+ days) |
Per Diem |
$187.34 |
$180.07 |
G0299 (RN services) G0155 (Social Worker services) |
Service Intensity Add-on |
Per Hour/Max four hours |
$71.61 |
$68.84 |
T2043 |
Continuous Home Care |
Per Hour |
$71.62 |
$68.84 |
T2044 |
Inpatient Respite |
Per Diem |
$576.71 |
$554.33 |
T2045 |
General Inpatient |
Per Diem |
$1,239.64 |
$1,191.54 |
Berkshire |
Compliant Rate |
Noncompliant Rate |
||
T2042 |
Routine Home Care (one-60 days) |
Per Diem |
$223.82 |
$215.14 |
T2042 UD |
Routine Home Care (61+ days) |
Per Diem |
$176.68 |
$169.82 |
G0299 (RN services) G0155 (Social Worker services) |
Service Intensity Add-on |
Per Hour/Max four hours |
$67.02 |
$64.42 |
T2043 |
Continuous Home Care |
Per Hour |
$67.02 |
$64.42 |
T2044 |
Inpatient Respite |
Per Diem |
$546.20 |
$525.00 |
T2045 |
General Inpatient |
Per Diem |
$1,171.56 |
$1,126.11 |
Bristol |
Compliant Rate |
Noncompliant Rate |
||
T2042 |
Routine Home Care (one-60 days) |
Per Diem |
$218.78 |
$210.30 |
T2042 UD |
Routine Home Care (61+ days) |
Per Diem |
$172.71 |
$166.00 |
G0299 (RN services) G0155 (Social Worker services) |
Service Intensity Add-on |
Per Hour/Max four hours |
$65.31 |
$62.78 |
T2043 |
Continuous Home Care |
Per Hour |
$65.31 |
$62.78 |
T2044 |
Inpatient Respite |
Per Diem |
$534.82 |
$514.07 |
T2045 |
General Inpatient |
Per Diem |
$1,146.18 |
$1,101.71 |
Essex/Middlesex |
Compliant Rate |
Noncompliant Rate |
||
T2042 |
Routine Home Care (one-60 days) |
Per Diem |
$225.56 |
$216.81 |
T2042 UD |
Routine Home Care (61+ days) |
Per Diem |
$178.06 |
$171.15 |
G0299 (RN services) G0155 (Social Worker services) |
Service Intensity Add-on |
Per Hour/Max four hours |
$67.62 |
$64.99 |
T2043 |
Continuous Home Care |
Per Hour |
$67.62 |
$64.99 |
T2044 |
Inpatient Respite |
Per Diem |
$550.14 |
$528.79 |
T2045 |
General Inpatient |
Per Diem |
$1,180.36 |
$1,134.56 |
Franklin/Hampden/Hampshire |
Compliant Rate |
Noncompliant Rate |
||
T2042 |
Routine Home Care (one-60 days) |
Per Diem |
$218.61 |
$210.13 |
T2042 UD |
Routine Home Care (61+ days) |
Per Diem |
$172.57 |
$165.87 |
G0299 (RN services) G0155 (Social Worker services) |
Service Intensity Add-on |
Per Hour/Max four hours |
$65.25 |
$62.72 |
T2043 |
Continuous Home Care |
Per Hour |
$65.25 |
$62.72 |
T2044 |
Inpatient Respite |
Per Diem |
$534.43 |
$513.69 |
T2045 |
General Inpatient |
Per Diem |
$1,145.31 |
$1,100.87 |
Norfolk/Plymouth/Suffolk |
Compliant Rate |
Noncompliant Rate |
||
T2042 |
Routine Home Care (one-60 days) |
Per Diem |
$241.23 |
$231.88 |
T2042 UD |
Routine Home Care (61+ days) |
Per Diem |
$190.43 |
$180.04 |
G0299 (RN services) G0155 (Social Worker services) |
Service Intensity Add-on |
Per Hour/Max four hours |
$72.94 |
$70.12 |
T2043 |
Continuous Home Care |
Per Hour |
$72.95 |
$70.12 |
T2044 |
Inpatient Respite |
Per Diem |
$585.55 |
$562.82 |
T2045 |
General Inpatient |
Per Diem |
$1,259.35 |
$1,210.48 |
Worcester |
Compliant Rate |
Noncompliant Rate |
||
T2042 |
Routine Home Care (one-60 days) |
Per Diem |
$229.20 |
$220.31 |
T2042 UD |
Routine Home Care (61+ days) |
Per Diem |
$180.93 |
$173.91 |
G0299 (RN services) G0155 (Social Worker services) |
Service Intensity Add-on |
Per Hour/Max four hours |
$68.85 |
$66.18 |
T2043 |
Continuous Home Care |
Per Hour |
$68.85 |
$66.18 |
T2044 |
Inpatient Respite |
Per Diem |
$558.36 |
$536.69 |
T2045 |
General Inpatient |
Per Diem |
$1,198.69 |
$1,152.18 |
Rural: Dukes and Nantucket |
Compliant Rate |
Noncompliant Rate |
||
T2042 |
Routine Home Care (one-60 days) |
Per Diem |
$256.14 |
$246.20 |
T2042 UD |
Routine Home Care (61+ days) |
Per Diem |
$202.20 |
$194.34 |
G0299 (RN services) G0155 (Social Worker services) |
Service Intensity Add-on |
Per Hour/Max four hours |
$78.01 |
$74.99 |
T2043 |
Continuous Home Care |
Per Hour |
$78.02 |
$74.99 |
T2044 |
Inpatient Respite |
Per Diem |
$619.22 |
$595.19 |
T2045 |
General Inpatient |
Per Diem |
$1,334.47 |
$1,282.69 |
Use modifier TN for T2042 and T2043 when billing for members outside the county in which the provider is located.