Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 359.00 - Rates for Home and Community Based Services
Section 359.03 - Rate Provisions
Current through Register 1531, September 27, 2024
(1) Services Included in the Rate. The approved rate will include payment for all care and services that are part of the program of services of a Provider, as explicitly set forth in the terms of the purchase agreement between the Provider and the purchasing governmental unit(s).
(2) Reimbursement as Full Payment. Each Provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment for services included in the scope of 101 CMR 359.00 from any other source must be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the participant.
(3) Payment Limitations.
(4) Approved Rates. The approved rate will be the lowest of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 359.03(4).
Service |
HCBS Waiver |
Units |
Agency Rate |
Non-agency Rate |
|
Individual Provider (Self-employed Provider) |
Self-directed Service |
||||
Adult Companion |
ABI-N, MFP-CL |
Per 15 Min. |
$6.50 |
89.75% of Agency Rate |
89.75% of Agency Rate |
Assisted Living |
ABI-RH, MFP-RS |
Per Diem |
$112.02 |
N/A |
N/A |
Assistive Technology - devices |
ABI-N, ABI-RH, MFP-CL, MFP-RS |
Per Device |
I.C. |
N/A |
N/A |
Assistive Technology - evaluation and training |
ABI-N, ABI-RH, MFP-CL, MFP-RS |
Per 15 Min. |
See 101 CMR 423.00 Rates for Certain In-Home Basic Living Supports |
||
Chore |
ABI-N, MFP-CL |
Per 15 Min. |
$10.13 |
89.75% of Agency Rate |
89.75% of Agency Rate |
Community-based Day Supports |
ABI-N, ABI-RH, MFP-CL, MFP-RS |
Per 15 Min. |
See101 CMR 415.00: Rates for Community based Day Support Services; Levels A, B, C, & I |
N/A |
N/A |
Community Support and Navigation |
ABI-N, ABI-RH, MFP-CL, MFP-RS |
Per 15 Min. |
See101 CMR 444.00: Rates for Certain Substance Use Disorder Services: Recovery Support Navigator Service |
N/A |
N/A |
Community Family Training |
ABI-N, MFP-CL |
Per 15 Min. |
See101 CMR 414.00: Rates for Family Stabilization Services (Family Training rate divided by 4 to determine rate per 15-minute increments) |
89.75% of Agency Rate |
N/A |
Day Services |
ABI-N, ABI-RH, MFP-CL, MFP-RS |
Per Diem, |
Per Diem: $115.72 |
N/A |
N/A |
Day Services - partial per diem |
ABI-N, ABI-RH, MFP-CL, MFP-RS |
Partial Per Diem |
Partial Per Diem: $57.86 |
N/A |
N/A |
Home Accessibility Adaptations |
ABI-N, ABI-RH MFP-CL, MFP-RS |
Item |
I.C. |
N/A |
N/A |
Home Delivered Meals |
ABI-N, MFP-CL |
Meal |
$10 |
N/A |
N/A |
Home Health Aide |
ABI-N, MFP-CL |
Per 15 Min. |
See101 CMR 350.00: Home Health Services |
N/A |
N/A |
Homemaker |
ABI-N, MFP-CL |
Per 15 Min. |
$8.22 |
89.75% of Agency Rate |
89.75% of Agency Rate |
Independent Living Supports |
ABI-N, MFP-CL |
Per Diem |
$88.02 |
N/A |
N/A |
Individual Support and Community Habilitation |
ABI-N, ABI-RH, MFP-CL, MFP-RS |
Per 15 Min. |
See101 CMR 423.00: Rates for Certain Inhome Basic Living Sup-ports; Levels G-H & I |
89.69% of Agency Rate |
89.69% of Agency Rate |
Laundry |
ABI-N, MFP-CL |
Per Order |
$30.17 |
N/A |
N/A |
Occupational Therapy |
ABI-N, ABI-RH, MFP-CL, MFP-RS |
Per Visit |
See101 CMR 350.00: Home Health Services |
See101 CMR 339.00: Restorative Services (out-of-office visit rate) |
N/A |
Orientation and Mobility Services |
MFP-CL, MFP-RS |
Per 15 Min |
Level I: $33.58 Level II: $37.12 Level III: $40.66 |
Level I: $33.58 Level II: $37.12 Level III: $40.66 |
N/A |
Peer Support |
ABI-N, ABI-RH, MFP-CL, MFP-RS |
Per 15 Min. |
See101 CMR 414.00: Rates for Family Stabilization Services (rate divided by 4 to determine rate per 15-minute increments) |
89.75% of Agency Rate |
89.75% of Agency Rate |
Personal Care |
ABI-N, MFP-CL |
Per 15 Min. |
$8.22 |
See101 CMR 309.00: Rates for Certain Services for the Personal Care Attendant Program |
See101 CMR 309.00: Rates for Certain Services for the Personal Care Attendant Program |
Physical Therapy |
ABI-N, ABI-RH, MFP-CL, MFP-RS |
Per Visit |
See101 CMR 350.00: Home Health Services |
See101 CMR 339.00: Restorative Services (out-of-office visit rate) |
N/A |
Prevocational Services |
ABI-N, ABI-RH, MFP-CL, MFP- RS |
Per 15 Min. |
See101 CMR 419.00: Rates for Supported Employment Services (rate for Individual Supported Employment) |
N/A |
N/A |
Residential Family Training |
ABI-RH, MFP-RS |
Per 15 Min. |
See101 CMR 414.00: Rates for Family Stabilization Services (Family Training rate divided by 4 to determine rate per 15-minute increments) |
89.75% of Agency Rate |
N/A |
Residential Habilitation Room and Board |
ABI-RH, MFP-RS |
Per Diem |
See101 CMR 420.00: Rates for Adult Long-term Residential Services (Site Rates) |
N/A |
N/A |
Residential Habilitation Services |
ABI-RH, MFP-RS |
Per Diem |
See101 CMR 420.00: Rates for Adult Long-term Residential Services (Basic Lower Intensity, Basic, or Intermediate categories, Medical/Clinical Level 1, Medical/Clinical Level 2, or Medical/Clinical Level 3 |
N/A |
N/A |
Respite |
ABI-N, MFP-CL |
Per Diem |
I.C. |
N/A |
N/A |
Shared Home Supports |
ABI-N, MFP-CL |
Per Diem |
See101 CMR 411.00: Rates for Certain Placement, Support, and Shared Living Services (Operational Rate Level A, Stipend Levels 1, 2, or 3) |
N/A |
N/A |
Shared Living - 24 Hour Supports |
ABI-RH, MFP-RS |
Per Diem |
See101 CMR 411.00: Rates for Certain Placement, Support, and Shared Living Services |
N/A |
N/A |
Skilled Nursing - LPN |
ABI-N, ABI-RH, MFP-CL, MFP-RS |
Per Visit |
See101 CMR 350.00: Home Health Services (Rates for Skilled Nursing Services) |
N/A |
N/A |
Skilled Nursing - RN |
ABI-N, ABI-RH, MFP-CL, MFP-RS |
Per Visit |
See101 CMR 350.00: Home Health Services (Rates for Skilled Nursing Services) |
N/A |
N/A |
Specialized Medical Equipment |
ABI-N, ABI-RH, MFP-CL, MFP-RS |
Item |
See101 CMR 322.00: Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment |
See101 CMR 322.00: Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment |
N/A |
Speech Therapy |
ABI-N, ABI-RH, MFP-CL, MFP-RS |
Per Visit |
See101 CMR 350.00: Home Health Services |
See101 CMR 339.00: Restorative Services (out-of-office visit rate) |
N/A |
Supported Employment |
ABI-N, ABI-RH, MFP-CL, MFP-RS |
Per 15 Min. |
See101 CMR 419.00: Rates for Supported Employment Services (rate for Individual Supported Employment) |
N/A |
N/A |
Supportive Home Care Aide |
ABI-N, MFP-CL |
Per 15 Min. |
See101 CMR 350.00: Home Health Services (13.12% above the rate for Home Health Aide) |
N/A |
N/A |
Transitional Assistance |
ABI-N, ABI-RH, MFP-CL, MFP-RS |
Per Episode |
I.C. |
N/A |
N/A |
Transportation |
ABI-N, ABI-RH, MFP-CL, MFP-RS |
One-way Trip |
See101 CMR 327.00: Rates of Payment for Ambulance and Wheelchair Van Services |
N/A |
N/A |
Vehicle Modification |
ABI-N, MFP-CL |
Item |
I.C. |
N/A |
N/A |
(5) Self-directed Service Rates.
Service |
Unit |
Self-directed Worker Rate |
Employer Expense Component |
Self-directed Service Rate |
Adult Companion |
Per 15 Min. |
$5.23 |
$0.60 |
$5.83 |
Chore |
Per 15 Min. |
$8.16 |
$0.93 |
$9.09 |
Homemaker |
Per 15 Min. |
$6.63 |
$0.75 |
$7.38 |
Individual Supports and Community Habilitation: Level G |
Per 15 Min. |
$9.32 |
$1.06 |
$10.38 |
Individual Supports and Community Habilitation: Level H |
Per 15 Min. |
$10.04 |
$1.14 |
$11.18 |
Individual Supports and Community Habilitation: Level I |
Per 15 Min. |
$12.27 |
$1.40 |
$13.67 |
Peer Support |
Per 15 Min. |
$6.32 |
$0.72 |
$7.04 |
Personal Care |
Per 15 Min. |
See101 CMR 309.00: Rates for Certain Services for the Personal Care Attendant Program (rate divided by four to determine rate per 15-minute increments) |
(6) Approved Modifiers. Below are the approved modifiers for all four HCBS Waiver programs:
Modifier |
Description |
U1 |
Agency Provider |
U2 |
Individual/Self-employed Provider |
U4 |
ABI Nonresidential Habitation (ABI-N) Waiver |
U5 |
ABI Residential Habitation (ABI-RH) Waiver |
U8 |
MFP Community Living (MFP-CL) Waiver |
U9 |
MFP Residential Supports (MFP-RS) Waiver |
UB |
Self-directed Service |
Service |
Agency |
Individual Provider (Self-employed Provider) |
Self-directed Service |
||||||
Code |
1st Position Modifier |
2nd Position Modifier |
Code |
1st Position Modifier |
2nd Position Modifier |
Code |
1st Position Modifier |
2nd Position Modifier |
|
Adult Companion |
- |
- |
- |
S5125 |
U4 |
- |
S5125 |
U4 |
UB |
- |
- |
- |
S5125 |
U8 |
- |
S5125 |
U8 |
UB |
|
S5135 |
U4 |
- |
- |
- |
- |
- |
- |
- |
|
S5135 |
U8 |
- |
- |
- |
- |
- |
- |
- |
|
Assisted Living |
T2031 |
U5 |
- |
- |
- |
- |
- |
- |
- |
T2031 |
U9 |
- |
- |
- |
- |
- |
- |
- |
|
Assistive Technology -devices |
T2029 |
U4 |
- |
- |
- |
- |
- |
- |
|
T2029 |
U5 |
- |
- |
- |
- |
- |
- |
||
T2029 |
U8 |
- |
- |
- |
- |
- |
- |
||
T2029 |
U9 |
- |
- |
- |
- |
- |
- |
||
Assistive Technology -evaluation and training |
97755 |
U4 |
|||||||
97755 |
U5 |
||||||||
97755 |
U8 |
||||||||
97755 |
U9 |
||||||||
Chore Services |
S5120 |
U4 |
U1 |
S5120 |
U4 |
U2 |
S5120 |
U4 |
UB |
S5120 |
U8 |
U1 |
S5120 |
U8 |
U2 |
S5120 |
U8 |
UB |
|
Community-based Day Supports |
S5100 |
U4 |
- |
- |
- |
- |
- |
- |
|
S5100 |
U4 |
U1 |
- |
- |
- |
- |
- |
||
S5100 |
U4 |
U2 |
|||||||
S5100 |
U4 |
U3 |
|||||||
S5100 |
U5 |
- |
- |
- |
- |
- |
- |
- |
|
S5100 |
U5 |
U1 |
- |
- |
- |
- |
- |
- |
|
S5100 |
U5 |
U2 |
- |
- |
- |
- |
- |
- |
|
S5100 |
U5 |
U3 |
- |
- |
- |
- |
- |
- |
|
S5100 |
U8 |
- |
- |
- |
- |
- |
- |
- |
|
S5100 |
U8 |
U1 |
- |
- |
- |
- |
- |
- |
|
S5100 |
U8 |
U2 |
- |
- |
- |
- |
- |
- |
|
S5100 |
U8 |
U3 |
- |
- |
- |
- |
- |
- |
|
S5100 |
U9 |
- |
- |
- |
- |
- |
- |
- |
|
S5100 |
U9 |
U1 |
- |
- |
- |
- |
- |
- |
|
S5100 |
U9 |
U2 |
- |
- |
- |
- |
- |
- |
|
S5100 |
U9 |
U3 |
- |
- |
- |
- |
- |
- |
|
Community Support and Navigation |
H2015 |
U4 |
- |
- |
- |
- |
- |
- |
- |
H2015 |
U5 |
- |
- |
- |
- |
- |
- |
- |
|
H2015 |
U8 |
- |
- |
- |
- |
- |
- |
- |
|
H2015 |
U9 |
- |
- |
- |
- |
- |
- |
- |
|
Community Family Training |
S5110 |
U4 |
U1 |
S5110 |
U4 |
U2 |
|||
S5110 |
U8 |
U1 |
S5110 |
U8 |
U2 |
- |
- |
- |
|
Day Services |
S5102 |
U4 |
- |
- |
- |
- |
- |
- |
|
S5102 |
U5 |
- |
- |
- |
- |
- |
- |
- |
|
S5102 |
U8 |
- |
- |
- |
- |
- |
- |
- |
|
S5102 |
U9 |
- |
- |
- |
- |
- |
- |
- |
|
Day Services -partial per diem |
S5102 |
U4 |
|||||||
S5102 |
U5 |
||||||||
S5102 |
U8 |
- |
|||||||
S5102 |
U9 |
- |
|||||||
Home Accessibility Adaptations |
S5165 |
U4 |
- |
- |
- |
- |
- |
||
S5165 |
U5 |
- |
- |
- |
- |
- |
|||
S5165 |
U8 |
- |
S5165 |
U8 |
|||||
S5165 |
U9 |
- |
S5165 |
U9 |
- |
- |
- |
- |
|
Home Delivered Meals |
S5170 |
U4 |
- |
- |
- |
- |
- |
- |
- |
S5170 |
U8 |
||||||||
Homemaker |
S5130 |
U4 |
U1 |
S5130 |
U4 |
U2 |
S5130 |
U4 |
UB |
S5130 |
U8 |
U1 |
S5130 |
U8 |
U2 |
S5130 |
U8 |
UB |
|
Home Health Aide |
G0156 |
U4 |
|||||||
G0156 |
U8 |
- |
- |
- |
- |
- |
- |
- |
|
Independent Living Supports |
H0043 |
U4 |
|||||||
H0043 |
U8 |
- |
- |
- |
- |
- |
- |
- |
|
Individual Support and Community Habilitation (Individual Provider/Self-directed Worker) |
- |
- |
- |
H2014 |
U4 |
U1, U2, U3 |
H2014 |
U4 |
U1, UB U2, UB U3, UB |
- |
- |
- |
H2014 |
U8 |
U1, U2, U3 |
H2014 |
U8 |
U1, UB U2, UB U3, UB |
|
H2014 |
U9 |
U1, U2, U3 |
H2014 |
U9 |
- |
||||
Individual Support and Community Habilitation (Agency) |
S5108 |
U4 |
U1, U2, U3 |
- |
- |
- |
- |
- |
- |
S5108 |
U8 |
U1, U2, U3 |
- |
- |
- |
- |
- |
- |
|
S5108 |
U9 |
U1, U2, U3 |
- |
- |
- |
- |
- |
- |
|
Laundry |
S5175 |
U4 |
- |
- |
- |
- |
- |
- |
- |
S5175 |
U8 |
- |
|||||||
Occupational Therapy |
S9129 |
U4 |
U1 |
S9129 |
U4 |
U2 |
- |
- |
- |
S9129 |
U5 |
U1 |
S9129 |
U5 |
U2 |
- |
- |
- |
|
S9129 |
U8 |
U1 |
S9129 |
U8 |
U2 |
- |
- |
- |
|
S9129 |
U9 |
U1 |
S9129 |
U9 |
U2 |
- |
- |
- |
|
Orientation and Mobility Services |
H2021 |
U4 |
U1, U2, U3 |
H2021 |
U4 |
U1, U2, U3 |
|||
H2021 |
U5 |
U1, U2, U3 |
H2021 |
U5 |
U1, U2, U3 |
||||
H2021 |
U8 |
U1, U2, U3 |
H2021 |
U8 |
U1, U2, U3 |
- |
- |
- |
|
H2021 |
U9 |
U1, U2, U3 |
H2021 |
U9 |
U1, U2, U3 |
- |
- |
- |
|
Peer Support |
H0038 |
U4 |
U1 |
H0038 |
U4 |
U2 |
H0038 |
U4 |
UB |
H0038 |
U5 |
U1 |
H0038 |
U5 |
U2 |
H0038 |
U5 |
UB |
|
H0038 |
U8 |
U1 |
H0038 |
U8 |
U2 |
H0038 |
U8 |
UB |
|
H0038 |
U9 |
U1 |
H0038 |
U9 |
U2 |
H0038 |
U9 |
UB |
|
Personal Care |
T1019 |
U4 |
- |
- |
- |
- |
- |
- |
- |
T1019 |
U8 |
U1 |
T1019 |
U8 |
U2 |
T1019 |
U8 |
UB |
|
Physical Therapy |
S9131 |
U4 |
U1 |
S9131 |
U4 |
U2 |
- |
- |
- |
S9131 |
U5 |
U1 |
S9131 |
U5 |
U2 |
- |
- |
- |
|
S9131 |
U8 |
U1 |
S9131 |
U8 |
U2 |
- |
- |
- |
|
S9131 |
U9 |
U1 |
S9131 |
U9 |
U2 |
- |
- |
- |
|
Prevocational Services |
T2019 |
U4 |
|||||||
T2019 |
U5 |
- |
- |
- |
- |
- |
- |
- |
|
T2019 |
U8 |
- |
- |
- |
- |
- |
- |
- |
|
T2019 |
U9 |
- |
- |
- |
- |
- |
- |
- |
|
Residential Family Training |
S5110 |
U5 |
U1 |
S5110 |
U5 |
U2 |
|||
S5110 |
U9 |
U1 |
S5110 |
U9 |
U2 |
- |
- |
- |
|
Residential Habilitation |
T2016 |
U5 |
- |
- |
- |
- |
- |
- |
- |
T2016 |
U9 |
- |
- |
- |
- |
- |
- |
- |
|
Respite |
H0045 |
U4 |
- |
- |
- |
- |
- |
- |
- |
H0045 |
U8 |
- |
- |
- |
- |
- |
- |
- |
|
Shared Home Supports |
H2016 |
U4 |
U1 |
||||||
H2016 |
U4 |
U2 |
|||||||
H2016 |
U4 |
U3 |
|||||||
H2016 |
U8 |
U1- |
- |
- |
- |
- |
- |
- |
|
H2016 |
U8 |
U2 |
- |
- |
- |
- |
- |
- |
|
H2016 |
U8 |
U3 |
- |
- |
- |
- |
- |
- |
|
Shared Living -24-hour Supports |
T2033 |
U5 |
- |
- |
- |
- |
- |
- |
- |
T2033 |
U9 |
- |
- |
- |
- |
- |
- |
- |
|
Skilled Nursing - RN |
G0299 |
U4 |
|||||||
G0299 |
U5 |
||||||||
G0299 |
U8 |
- |
- |
- |
- |
- |
- |
- |
|
G0299 |
U9 |
- |
- |
- |
- |
- |
- |
- |
|
Skilled Nursing - LPN |
G0300 |
U4 |
|||||||
G0300 |
U5 |
||||||||
G0300 |
U8 |
- |
- |
- |
- |
- |
- |
- |
|
G0300 |
U9 |
- |
- |
- |
- |
- |
- |
- |
|
Specialized Medical Equipment |
T2029 |
U4 |
- |
T2029 |
U4 |
- |
- |
- |
- |
T2029 |
U5 |
- |
T2029 |
U4 |
- |
- |
- |
- |
|
T2029 |
U8 |
- |
- |
- |
- |
- |
- |
- |
|
T2029 |
U9 |
- |
- |
- |
- |
- |
- |
- |
|
Speech Therapy |
S9128 |
U4 |
U1 |
S9128 |
U4 |
U2 |
- |
- |
- |
S9128 |
U5 |
U1 |
S9128 |
U5 |
U2 |
- |
- |
- |
|
S9128 |
U8 |
U1 |
S9128 |
U8 |
U2 |
- |
- |
- |
|
S9128 |
U9 |
U1 |
S9128 |
U9 |
U2 |
- |
- |
- |
|
Supported Employment |
H2023 |
U4 |
- |
- |
- |
- |
- |
- |
- |
H2023 |
U5 |
- |
- |
- |
- |
- |
- |
- |
|
H2023 |
U8 |
- |
- |
- |
- |
- |
- |
- |
|
H2023 |
U9 |
- |
- |
- |
- |
- |
- |
- |
|
Supportive Home Care Aide |
T1004 |
U4 |
|||||||
T1004 |
U8 |
- |
- |
- |
- |
- |
- |
- |
|
Transportation |
T2003 |
U4 |
- |
- |
- |
- |
- |
- |
- |
T2003 |
U5 |
- |
- |
- |
- |
- |
- |
- |
|
T2003 |
U8 |
- |
- |
- |
- |
- |
- |
- |
|
T2003 |
U9 |
- |
- |
- |
- |
- |
- |
- |
|
Transitional Assistance |
T2038 |
U4 |
- |
- |
- |
- |
- |
- |
- |
T2038 |
U5 |
- |
- |
- |
- |
- |
- |
- |
|
T2038 |
U8 |
- |
- |
- |
- |
- |
- |
- |
|
T2038 |
U9 |
- |
- |
- |
- |
- |
- |
- |
|
Vehicle Modification |
T2039 |
U4 |
|||||||
T2039 |
U8 |
- |
- |
- |
- |
- |
- |
- |