Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 413.00 - Payments for Youth Intermediate-term Stabilization Services
Section 413.03 - Rate Provisions

Universal Citation: 101 MA Code of Regs 101.413

Current through Register 1531, September 27, 2024

(1) Services Included in the Rate. The approved rate includes payment for all care and services that are part of the program of services of an eligible provider, as explicitly set forth by the purchasing governmental unit(s).

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of payment by any purchasing governmental unit, accept the approved rate as full payment and discharge of all obligations for the services rendered. Payment by the purchasing governmental unit for services rendered to the client are reduced by the amount of any payment from any other source.

(3) Payment Limitations. No purchasing governmental unit may pay less than, or more than, the approved rate, except as cited in 101 CMR 413.03(2), (4), and (5).

(4) Administrative Adjustment for Extraordinary Circumstances. A method whereby, subject to availability of funds, a purchasing governmental unit may provide additional resource allocations to a qualified provider in response to unusual and unforeseen circumstances that substantially increase the cost of service delivery in ways not contemplated in the development of current rates. It must be demonstrated that such cost increases gravely threaten the stability of service provision such that client or consumer access to necessary services is at risk. The purchasing governmental unit will evaluate the need for the administrative adjustment, determine whether funding is available, and convey that information to EOHHS for review to determine the amount of any adjustment.

(5) Approved Rates. Except for the rates established for substance use disorder treatment, the rates set forth in 101 CMR 413.03 govern the payment rates for services purchased by the Department of Children and Families, DMH, and DYS provided pursuant to contracts executed under the departments' FY 2013 or subsequent procurements. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 413.03.

(a) Youth Residential Substance Use Disorder Treatment Rates Effective for Dates of Service Provided on or after January 1, 2024.

Program Name

Rate

HCPCS Code/Description

Youth Residential Substance

Use Disorder Treatment

$397.89

H0019-HF - Behavioral health; long-term residential (nonmedical, nonacute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem (residential treatment service for transitional age youth and young adults: youth residential substance use disorder treatment).

Clinically Intensive Youth Residential Substance Use Disorder Treatment

$523.57

H0019-HA - Behavioral health; long-term residential (nonmedical, nonacute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem (residential treatment services for youth: clinically intensive youth residential substance use disorder treatment).

(b) Adjudicated Youth Residential Treatment Base Rates Effective for Dates of Service Provided on or after January 1, 2024.

ADJUDICATED YOUTH RESIDENTIAL TREATMENT BASE RATES

PROVIDER LEASED

Utilization %

# of Clients

12-14

15-17

18-22

23-26

90%

$627.83

$525.21

$425.63

$386.26

85%

$664.76

$556.11

$450.67

$408.98

80%

$706.31

$590.86

$478.83

$434.54

75%

$753.40

$630.25

$510.76

$463.51

70%

$807.21

$675.27

$547.24

$496.62

65%

$869.30

$727.22

$589.33

$534.82

60%

$941.74

$787.82

$638.45

$579.39

55%

$1,027.36

$859.44

$696.49

$632.06

50%

$1,130.09

$945.38

$766.13

$695.26

PROVIDER OWNED

Utilization %

# of Clients

12-14

15-17

18-22

23-26

90%

$587.40

$484.78

$385.20

$345.83

85%

$621.95

$513.30

$407.86

$366.17

80%

$660.83

$545.38

$433.35

$389.06

75%

$704.88

$581.74

$462.24

$414.99

70%

$755.23

$623.29

$495.26

$444.64

65%

$813.32

$671.24

$533.36

$478.84

60%

$881.10

$727.18

$577.80

$518.74

55%

$961.20

$793.28

$630.33

$565.90

50%

$1,057.32

$872.61

$693.36

$622.49

STATE OWNED - SEPARATE

Utilization %

# of Clients

12-14

15-17

18-22

23-26

90%

$579.70

$477.08

$377.50

$357.80

85%

$613.80

$505.15

$399.71

$378.84

80%

$652.16

$536.72

$424.69

$402.52

75%

$695.64

$572.50

$453.00

$429.36

70%

$745.33

$613.39

$485.36

$460.02

65%

$802.66

$660.58

$522.69

$495.41

60%

$869.55

$715.62

$566.25

$536.69

55%

$948.60

$780.68

$617.73

$585.49

50%

$1,043.46

$858.75

$679.50

$644.03

STATE OWNED - CO-LOCATED

Utilization %

# of Clients

12-14

15-17

18-22

23-26

90%

$543.96

$451.26

$357.43

$338.74

85%

$575.96

$477.81

$378.45

$358.66

80%

$611.96

$507.67

$402.11

$381.08

75%

$652.76

$541.51

$428.91

$406.48

70%

$699.38

$580.19

$459.55

$435.52

65%

$753.18

$624.82

$494.90

$469.02

60%

$815.95

$676.89

$536.14

$508.11

55%

$890.12

$738.43

$584.88

$554.30

50%

$979.14

$812.27

$643.37

$609.73

Intensive Trans. Indep. Living (A)

Utilization %

# of Clients

5-11

12-14

15-17

18-22

90%

$468.70

$425.88

$420.04

$399.76

85%

$496.27

$450.93

$444.75

$423.28

80%

$527.29

$479.11

$472.55

$449.74

75%

$562.44

$511.06

$504.05

$479.72

70%

$602.61

$547.56

$540.05

$513.98

65%

$648.97

$589.68

$581.59

$553.52

60%

$703.05

$638.82

$630.06

$599.65

55%

$766.96

$696.89

$687.34

$654.16

50%

$843.66

$766.58

$756.07

$719.58

Trans. Indep. Living (B)

Utilization %

# of Clients

5-11

12-14

15-17

18-22

90%

$183.69

$131.16

$145.15

$129.30

85%

$194.50

$138.88

$153.69

$136.91

80%

$206.66

$147.56

$163.29

$145.46

75%

$220.43

$157.40

$174.18

$155.16

70%

$236.18

$168.64

$186.62

$166.25

65%

$254.35

$181.61

$200.98

$179.03

60%

$275.54

$196.74

$217.73

$193.95

55%

$300.59

$214.63

$237.52

$211.59

50%

$330.65

$236.09

$261.27

$232.74

STATE OWNED - CO-LOCATED

Utilization %

# of Clients:

12-14

15-17

18-22

23-26

90%

$427.64

$358.65

$321.72

$299.45

85%

$452.80

$379.75

$340.63

$317.07

80%

$481.09

$403.49

$361.93

$336.87

75%

$513.17

$430.39

$386.06

$359.34

70%

$549.83

$461.13

$413.63

$385.01

65%

$592.12

$496.60

$445.45

$414.61

60%

$641.46

$537.98

$482.56

$449.17

55%

$699.77

$586.89

$526.44

$490.00

50%

$769.75

$645.59

$579.08

$539.00

(c) Residential, Community-based, and Specialty Services (Formerly Known as Caring Together) Rates Effective for Dates of Service Provided on or after January 1, 2024.

RESIDENTIAL SERVICES (Formerly known as Caring Together)

Program Type

Model

Rate per Month

CIRT

Clinically Intensive Residential Treatment

$222,265

IRTP

Intensive Residential Treatment Program, co-located

$283,502

Intensive Residential Treatment Program, not co-located

$288,141

STARR

Six Beds

$66,404

Nine Beds

$87,476

12 Beds

$116,238

15 Beds

$139,510

Teen Parenting

TLP 1:5 (per slot)

$6,358

House Parent (per slot)

$6,420

STEP (per slot)

$3,024

RESIDENTIAL SERVICES (Formerly known as Caring Together)

Program Type

Model

Rate per Diem

Group Home

Intensive 1:3

$354.02

Group Home 1:4

$297.74

Pre-independent Living

$255.54

Independent Living

$110.35

STARR

Six Bed

$418.50

Nine Beds

$367.73

12 Beds

$345.74

15 Beds

$332.25

Teen Parenting

Enhanced 1:4

$295.59

COMMUNITY-BASED SERVICES (Formerly known as Caring Together)

Program Type

Model

Rate per Diem

Continuum

Community Wrap

$119.02

Adjusted GH 1:3

$357.77

Adjusted GH 1:4

$297.07

Follow Along

$69.63

Stepping Out

$48.45

Specialty Services (Formerly known as Caring Together)

Service

Rate per Diem

Transitional Age Youth: Adult Continuum

$164.03

Transitional Age Youth: Young Adult Group Living Environment

$355.74

Intensive 1:1 Supported Living

$697.09

Intensive 1:2 Group Home

$434.50

Intensive 1:3 Group Home with expanded nursing

$417.31

Medically Complex Needs GH, nine beds

$494.08

Medically Complex Needs GH, nine beds with expanded nursing

$585.04

Medically Complex Needs GH, six beds

$516.57

Medically Complex Needs GH, six beds with expanded nursing

$658.53

Medically Complex Needs GH, 12 beds

$462.24

Medically Complex Needs GH, 12 beds with expanded nursing

$523.59

Transition to IFC Add-on

$41.66

Teen Parenting Emergency Beds Add-on (per day)

$15.24

Teen Parenting Emergency Beds Add-on (per month)

$463.50

(d) Congregate Care Program Rates Effective for Dates of Service Provided on or after July 1, 2023.

Congregate Care Program

Rate

Unit

Clinically Intensive Residential Treatment

$388,523

monthly program rate

Community Treatment Residence (Non-ERTP)

$522.47

per bed day

Community Treatment Residence (ERTP)

$545.04

per bed day

Intensive Home Based Therapeutic Care

$189.18

per day per person

Emergency Residence

$636.00

per bed day

Intensive Emergency Residence

$755.87

per bed day

Intensive Residential Treatment Program

$497,888

monthly program rate

Intensive Treatment Residence (Non-ERTP)

$777.62

per bed day

Intensive Treatment Residence (ERTP)

$794.19

per bed day

Intensive Treatment Residence Emergency Intake-Add-on

$119.42

per bed day

Medically Complex & Behavioral Residence (Non-ERTP)

$737.48

per bed day

Medically Complex & Behavioral Residence (ERTP)

$754.05

per bed day

Medically Complex Residence (Non-ERTP)

$759.25

per bed day

Medically Complex Residence (ERTP)

$771.68

per bed day

Specialty Treatment Residence (Commercially Sexually Exploited Children)

$668.66

per bed day

Specialty Treatment Residence (Non-ERTP)

$660.85

per bed day

Specialty Treatment Residence (ERTP)

$674.03

per bed day

Therapeutic Group Care - 6 beds

$99,178

monthly program rate

Therapeutic Group Care - 9 beds

$135,891

monthly program rate

Therapeutic Group Care - 12 beds

$170,267

monthly program rate

Young Adult Supported Living

$195.39

per bed day

Young Adult Therapeutic Care -Outreach

$63.21

daily slot rate

Young Adult Therapeutic Care -Staffed Apartments

$87,633

monthly program rate

Young Adult Therapeutic Care -Staffed Apartments

$14,605

monthly single apt.

Young Adult Therapeutic Care -Supported Apartments

$6,236

monthly single apt.

Young Adult Therapeutic Care -Supported Apartments Hold

$65.52

daily rate

Young Parent Assessment

$406.33

per assessment

Young Parent Living Program

$9,481.57

monthly bed rate

Youth & Young Adult Group Residence

$408.96

per bed day

Youth & Young Adult Supported Living Community

$378.49

per bed day

(e) Add-on Rates Effective for Dates of Service Provided on or after January 1, 2024.

Add-on Rates (Monthly)

Position

1.0 FTE

0.75 FTE

0.50 FTE

0.25 FTE

Direct Care

$4,244

$3,183

$2,122

$1,061

Certified Nursing Assistant

$4,023

$3,017

$2,011

$1,006

Direct Care III

$5,415

$4,061

$2,708

$1,354

Occupational Therapist

$8,634

$6,475

$4,317

$2,158

Occupational Therapist Assistant

$7,137

$5,353

$3,568

$1,784

Case Manager, Social Worker, Clinician (MA level-not Independent Licensed)

$6,829

$5,122

$3,414

$1,707

LPN

$6,497

$4,873

$3,248

$1,624

Registered Nurse

$10,523

$7,893

$5,262

$2,631

Clinician w/Independent License

$7,858

$5,894

$3,929

$1,965

Social/Caseworker (BA Level)

$5,448

$4,086

$2,724

$1,362

Add-on Rates (Hourly)

Position

Rate

Direct Care

$26.10

Certified Nursing Assistant

$24.73

Direct Care III

$33.29

Occupational Therapist

$58.86

Occupational Therapist Assistant

$48.68

Case Manager, Social Worker, Clinician (MA level - not Independent Licensed)

$46.57

LPN

$44.30

Registered Nurse

$71.77

Clinician w/Independent License

$53.60

Social/Caseworker (BA Level)

$37.17

Nurse Practitioner/APRN

$94.45

Psychologist/Psychiatrist (PhD)

$152.17

Forensic Psychiatrist

$181.00

Other Add-on Rates

Service

Rate

Canine Therapy

$10,000 per dog

Extraordinary Circumstances/Flex Funding

Individual Consideration (I.C.)

Adjudicated Youth Residential Treatment Add-on Rates

Position - Add-on

Unit

Rate

Clinical Director

Per Youth, Per Day

$37.69

Clinician (LICSW)

Per Youth, Per Day

$29.96

Direct Care

Per Youth, Per Day

$15.46

(f) Community Service Network (CSN)/READY Rates Effective for Dates of Service Provided on or after January 1, 2024.

Community Service Network (CSN)/READY

Rates are based on region, and reflect per client per enrollment day.

Model

Rate per Client per Enrollment Day

Central Region

$44.05

Metro Boston Region

$62.81

Northeast Region

$32.22

Southeast Region

$38.65

West Region

$41.16

Community Service Network (CSN) Add-on Rates

Add-on

Unit

Rate

Occupancy Add-on:

Monthly

$10,000.00

Youth Service Coordinator Add-on: 0.50 FTE

Monthly

$2,900

Youth Service Coordinator Add-on: 1.0 FTE

Monthly

$5,801

Administrative Assistant/Transporter Add-on: 0.50 FTE

Monthly

$2,268

Administrative Assistant/Transporter Add-on: 1.0 FTE

Monthly

$4,536

READY Program: 1.0 FTE

Enrolled Day

$19.61

(6) Geographic Regions for Community Service Network.

(a) Central: Ashburnham, Ashby, Ashland, Athol, Auburn, Ayer, Barre, Bellingham, Berlin, Blackstone, Bolton, Boylston, Brookfield, Charlton, Clinton, Douglas, Dover, Dudley, East Brookfield, Fitchburg, Framingham, Franklin, Gardner, Grafton, Groton, Hardwick, Harvard, Holden, Holliston, Hopedale, Hopkinton, Hubbardston, Hudson, Lancaster, Leicester, Leominster, Lunenburg, Marlborough, Medway, Mendon, Milford, Millbury, Millville, Natick, Needham, New Braintree, North Brookfield, Northborough, Northbridge, Oakham, Oxford, Paxton, Pepperell, Petersham, Phillipston, Princeton, Royalston, Rutland, Sherborn, Shirley, Shrewsbury, Southborough, Southbridge, Spencer, Sterling, Sturbridge, Sudbury, Sutton, Templeton, Townsend, Upton, Uxbridge, Warren, Wayland, Webster, Wellesley, West Boylston, West Brookfield, Westborough, Westminster, Weston, Winchendon, Worcester.

(b) Metropolitan Boston: Belmont, Boston, Brookline, Cambridge, Chelsea, Newton, Revere, Somerville, Waltham, Watertown, Winthrop.

(c) Northeast: Acton, Amesbury, Andover, Arlington, Bedford, Beverly, Billerica, Boxborough, Boxford, Burlington, Carlisle, Chelmsford, Concord, Danvers, Dracut, Dunstable, Essex, Everett, Georgetown, Gloucester, Groveland, Hamilton, Haverhill, Ipswich, Lawrence, Lexington, Lincoln, Littleton, Lowell, Lynn, Lynnfield, Malden, Manchester-by-the-Sea, Marblehead, Maynard, Medford, Melrose, Merrimac, Methuen, Middleton, Nahant, Newbury, Newburyport, North Andover, North Reading, Peabody, Reading, Rockport, Rowley, Salem, Salisbury, Saugus, Stoneham, Stow, Swampscott, Tewksbury, Topsfield, Tyngsborough, Wakefield, Wenham, Westford, West Newbury, Wilmington, Winchester, Woburn.

(d) Southeast: Abington, Acushnet, Aquinnah, Attleboro, Avon, Barnstable, Berkeley, Bourne, Braintree, Brewster, Bridgewater, Brockton, Canton, Carver, Chatham, Chilmark, Cohasset, Dartmouth, Dedham, Dennis, Dighton, Duxbury, East Bridgewater, Eastham, Easton, Edgartown, Fairhaven, Fall River, Falmouth, Foxborough, Freetown, Gosnold, Halifax, Hanover, Hanson, Harwich, Hingham, Holbrook, Hull, Kingston, Lakeville, Mansfield, Marion, Marshfield, Mashpee, Mattapoisett, Medfield, Middleborough, Millis, Milton, Nantucket, New Bedford, Norfolk, North Attleboro, Norton, Norwell, Norwood, Oak Bluffs, Orleans, Pembroke, Plainville, Plymouth, Plympton, Provincetown, Quincy, Randolph, Raynham, Rehoboth, Rochester, Rockland, Sandwich, Scituate, Seekonk, Sharon, Somerset, Stoughton, Swansea, Taunton, Tisbury, Truro, Walpole, Wareham, Wellfleet, West Bridgewater, Westport, West Tisbury, Westwood, Weymouth, Whitman, Wrentham, Yarmouth.

(e) West: Adams, Agawam, Alford, Amherst, Ashfield, Becket, Belchertown, Bernardston, Blandford, Brimfield, Buckland, Charlemont, Cheshire, Chester, Chesterfield, Chicopee, Clarksburg, Colrain, Conway, Cummington, Dalton, Deerfield, Easthampton, East Longmeadow, Egremont, Erving, Florida, Gill, Goshen, Granby, Granville, Great Barrington, Greenfield, Hadley, Hampden, Hancock, Hatfield, Hawley, Heath, Hinsdale, Holland, Holyoke, Huntington, Lanesborough, Lee, Lenox, Leverett, Leyden, Longmeadow, Ludlow, Middlefield, Monroe, Monson, Montague, Monterey, Montgomery, Mount Washington, New Ashford, New Marlborough, New Salem, North Adams, Northampton, Northfield, Orange, Otis, Palmer, Pelham, Peru, Pittsfield, Plainfield, Richmond, Rowe, Russell, Sandisfield, Savoy, Sheffield, Shelburne Falls, Shutesbury, Southampton, South Hadley, Southwick, Springfield, Stockbridge, Sunderland, Tolland, Tyringham, Wales, Ware, Warwick, Washington, Wendell, Westhampton, Westfield, West Springfield, West Stockbridge, Whately, Wilbraham, Williamsburg, Williamstown, Windsor, Worthington.

Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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