Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 348.00 - Rates for Day Habilitation Services
Section 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. 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. The approved rates cover all care and services associated with the provision of day habilitation services in a nursing facility.

(4) Supplemental Staffing 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. These services do not apply to nursing facility residents who receive day habilitation services at the nursing facility. The MassHealth agency will pay a supplemental rate to augment staffing ratios when an individual needs assistance for all or part of the time that an individual participates in a community day habilitation program and meets criteria established by the MassHealth agency. The approved supplemental rate, which includes salary, payroll taxes, and fringe benefits, is listed in 101 CMR 348.03(5).

(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.

(6) Individualized Staffing Supports. Effective October 1, 2022, certain qualifying individuals may need supplemental one-to-one care to enable their participation in the day habilitation program. The approved supplemental rates are listed in 101 CMR 348.03(6).