Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 433.00
Section 433.03 - Rate Provisions

Universal Citation: 101 MA Code of Regs 101.433

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 in the terms of the purchase agreement between the eligible provider and the purchasing governmental unit(s).

(2) Reimbursement as Full Payment. Each eligible 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 from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(4) Approved Rates with Applicable Dates of Service Provided on or after July 1, 2021. 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 433.03(4).

(a) Certain Substance Use Disorder Programs. Terms used in 101 CMR 433.03(4)(a) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 346.02: Definitions.

Service/Program

Code

Unit of Service

Rate

Youth Residential Substance Use Disorder Treatment

H0019-HF

Per Diem

$323.55

Clinically Intensive Youth Residential Substance Use Disorder Treatment

H0019-HA

Per Diem

$425.39

Residential Services

H0019

Per Diem

$149.20

Residential Rehab Pregnant Enhancement

H0019-TH

Per Diem

$41.58

Residential Rehab Postpartum Enhancement

H0019-HD

Per Diem

$93.35

Residential Rehab Child Enhancement

H0019-HV

Per Diem

$46.67

Medically Monitored Inpatient Detoxification

H0011

Per Diem

$420.77

Clinically Managed Inpatient Detoxification

H0010

Per Diem

$350.93

Transitional Support Services

H0018

Per Diem

$185.21

Second Offender Drive Alcohol Education Residential

H0018-H9

Per Diem

$148.82

Jail Diversion - Phase 1

H0019-H9

Per Diem

$222.81

Jail Diversion - Phase 2

H0006-H9

Per Hour

$61.53

Family Supportive Housing

H0019-HR

Per Diem

$197.63

Family Residential Treatment

H01019-HR

Per Diem

$327.92

Supportive Case Management - Permanent Adult

N/A

Enrolled Client Day

$12.43

Supportive Case Management - Permanent Families

N/A

Enrolled Client Day

$25.06

Supportive Case Management - Permanent Young Adult

N/A

Enrolled Client Day

$34.46

Supportive Case Management - Transitional Adult

N/A

Enrolled Client Day

$14.80

Supportive Case Management - Transitional Families

N/A

Enrolled Client Day

$29.79

Supportive Case Management - Transitional Young Adult

N/A

Enrolled Client Day

$40.17

Supportive Case Management - House Manager Add-on

N/A

Month

$2,917.00

Supportive Case Management - Outreach and Staffing

Supports

N/A

Month

$3,997.00

Supportive Case Management - Low Threshold

N/A

Enrolled Client Day

$51.43

Supportive Case Management - School Based Targeted Prevention

N/A

Month

$16,882.00

Triage, Engagement & Assessment Services - Model A -Base Rate

N/A

Monthly Per Slot

$952.00

Triage, Engagement & Assessment Services - Model A -Engagement Staff Rate

N/A

Monthly Per Slot

$534.00

Triage, Engagement & Assessment Services - Model A -Engagement Staff Rate Day Program Only

N/A

Monthly Per Slot

$273.00

Triage, Engagement & Assessment Services - Model B -Base Rate

N/A

Monthly Per Slot

$1,141.00

Triage, Engagement & Assessment Services - Model B -Engagement Staff Rate

N/A

Monthly Per Slot

$720.00

Triage, Engagement & Assessment Services - Model B -Engagement Staff Rate Day Program Only

N/A

Monthly Per Slot

$447.00

Triage, Engagement & Assessment Services - Peer Service Coordinator Add-on

N/A

Per Diem

$22.04

Triage, Engagement & Assessment Services - Social Worker LICSW Add-on

N/A

Per Diem

$38.08

Triage, Engagement & Assessment Services - Care Coordinator Add-on

N/A

Per Diem

$22.04

Triage, Engagement & Assessment Services - Direct Care Staff Add-on

N/A

Per Diem

$22.04

Triage, Engagement & Assessment Services - Support Staff Add-on

N/A

Per Diem

$22.04

Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 1

N/A

Monthly

$2,562.00

Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 2

N/A

Monthly

$3,611.00

Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 3

N/A

Monthly

$4,659.00

Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 4

N/A

Monthly

$5,708.00

Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 5

N/A

Monthly

$6,757.00

Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 6

N/A

Monthly

$8,108.00

Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 7

N/A

Monthly

$9,459.00

Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 8

N/A

Monthly

$10,810.00

Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 9

N/A

Monthly

$12,162.00

Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 10

N/A

Monthly

$13,513.00

Office Based Opioid Treatment (FQHCs) Wraparound Services - 25 Client Add-on

N/A

Monthly

$1,351.00

Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 1

N/A

Monthly

$4,714.00

Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 2

N/A

Monthly

$5,763.00

Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 3

N/A

Monthly

$6,811.00

Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 4

N/A

Monthly

$7,860.00

Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 5

N/A

Monthly

$8,908.00

Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 6

N/A

Monthly

$10,690.00

Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 7

N/A

Monthly

$12,472.00

Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 8

N/A

Monthly

$14,253.00

Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 9

N/A

Monthly

$16,035.00

Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 10

N/A

Monthly

$17,817.00

Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - 25 Client Add-on

N/A

Monthly

$3,503.00

Office Based Opioid Treatment - Hospital Wraparound Services - Tier 1

N/A

Monthly

$4,968.00

Office Based Opioid Treatment - Hospital Wraparound Services - Tier 2

N/A

Monthly

$8,495.00

Office Based Opioid Treatment - Hospital Wraparound Services - Tier 3

N/A

Monthly

$11,985.00

Office Based Opioid Treatment - Hospital Wraparound Services - Tier 4

N/A

Monthly

$15,501.00

Office Based Opioid Treatment - Hospital Wraparound Services - Tier 5

N/A

Monthly

$19,018.00

Office Based Opioid Treatment - Hospital Wraparound Services - Tier 6

N/A

Monthly

$22,821.00

Office Based Opioid Treatment - Hospital Wraparound Services - Tier 7

N/A

Monthly

$26,625.00

Office Based Opioid Treatment - Hospital Wraparound Services - Tier 8

N/A

Monthly

$30,428.00

Office Based Opioid Treatment - Hospital Wraparound Services - Tier 9

N/A

Monthly

$34,232.00

Office Based Opioid Treatment - Hospital Wraparound Services - Tier 10

N/A

Monthly

$38,035.00

Office Based Opioid Treatment - Hospital Wraparound Services - 25 Client Add-on

N/A

Monthly

$2,562.00

Office Based Opioid Treatment (FQHCs) Start-up - Level 1

N/A

Monthly

$8,659.00

Office Based Opioid Treatment (FQHCs) Start-up -Level 2

N/A

Monthly

$12,669.00

(b) Adult Housing and Community Support Services. Terms used in 101 CMR 433.03(4)(f) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 421.02: Definitions.
1. Program Rates.

Service/Program

Unit of Service

Rate

Outreach and Engagement

Month

$31,757

Safe Haven: ten to 12 beds

Enrolled day

$180.45

Safe Haven: seven to nine beds

Enrolled day

$200.40

Dual Diagnosis Shelter - donated space

Enrolled day

$163.66

Dual Diagnosis Shelter - with occupancy costs

Enrolled day

$184.38

Housing Options Program: Level 1

Enrolled month

$40.58

Housing Options Program: Level 2

Enrolled month

$165.45

Assertive Treatment and Relapse Prevention: Model A - nine to 12 clients

Enrolled day

$50.98

Assertive Treatment and Relapse Prevention: Model B - six to eight clients

Enrolled day

$48.57

2. Adult Housing and Community Support Service Add-on Rates.

Position Title

Per Diem

.25 FTE Monthly

.50 FTE Monthly

1.0 FTE Monthly

Direct Care

$166

$897

$1,793

$3,587

Direct Care III

$214

$1,161

$2,321

$4,643

LICSW

$302

$1,633

$3,267

$6,534

3. Congregate Care Hourly Add-on Rates.

Position

Hourly Rate

Direct Care

$22.04

Certified Nursing Assistant

$22.67

Direct Care III

$28.53

Occupational Therapist

$55.04

Occupational Therapist Assistant

$43.56

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

$38.10

LPN

$41.91

Registered Nurse

$63.20

Clinician with Independent License

$44.53

Social/Caseworker (BA Level)

$31.75

Nurse Practitioner/APRN

$86.75

(c) Youth And Young Adult Support Services. Terms used in 101 CMR 433.03(4)(g) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 427.02: Definitions.
1. Alternative Lock-up Program Rates.

Service/Program

Unit of Service

Rate

A

Monthly

$11,547

B

Monthly

$20,111

C

Monthly

$25,703

2. Conflict of Interest Program Rates.

Service/Program

Unit of Service

Rate

One Family

Monthly

$1,090

Five Families

Monthly

$5,448

3. Teen Pregnancy Prevention Program Rates.

Service/Program

Unit of Service

Rate

In school

Curriculum Hour

$324.70

Outside school

Curriculum Hour

$405.88

Remote Add-on

Hour

$81.18

Peer Leadership & Youth Development

Contact Hour

$243.53

Partnership Development

Hour

$46.70

4. Therapeutic Day Services Program Rates.

Service/Program

Unit of Service

Rate

Model 1

Month

$28,418

Model 2

Month

$24,586

Model 3A

Month

$25,547

Model 3B

Month

$34,615

Model 4A

Month

$20,030

Model 4B

Month

$37,806

5. Therapeutic Day Services Add-on Rates.

Title

Unit of Service

.25 FTE

.5 FTE

.75 FTE

1 FTE

Clinical (LICSW)

Monthly

$1,633

$3,268

$4,900

$6,534

Peer/Direct Care

Monthly

$897

$1,794

$2,690

$3,587

Direct Care III

Monthly

$1,160

$2,321

$3,481

$4,641

6. Young Parent Support Program Rates.

Service/Program

Unit of Service

Rate

Model A

Month

$8,435

Model B

Month

$16,869

YPS Specialty Direct Care III Add-on (.5 FTE)

Month

$2,321

YPS Specialty Direct Care III Add-on (1 FTE)

Month

$4,641

(d) Independent Living Community Programs. Terms used in 101 CMR 433.03(4)(h) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 428.02: Definitions.
1. Deaf and Hard of Hearing Independent Living Service Program Rates.

Service/Program

Unit of Service

Rate

DHILs - Region 1

Monthly

$46,315

DHILs - Region 2

Monthly

$40,707

DHILs - Region 3

Monthly

$36,502

DHILs - Region 4

Monthly

$33,600

DHILs - Region 5

Monthly

$21,841

DHILs - Region 6

Monthly

$18,927

DHILs - Region 7

Monthly

$11,631

DHILs - Region 8

Monthly

$7,495

2. Recovery Learning Communities Program Rates.

Service/Program

Unit of Service

Rate

Recovery Learning Communities

Monthly

$76,935

3. Vocational Rehabilitation Independent Living Service Program Rates.

Service/Program

Unit of Service

Rate

VRIL Service Add-on

Per Hour

$129

VRIL Assessment

Per Component

$515

Independent Living Skills Training

Per Component

$1,931

Community Resource Access

Per Component

$1,931

PASS Plan

Per Component

$1,931

Single Service Purchase

Per Component

$901

VRIL Group Training Add-on

Per Client per Class

$43.49

4. Independent Living Communities Add-on Rates.

Position

Unit of Service

Rate

Direct Care 0.25 FTE Add-on

Monthly

$1,161

Direct Care 0.5 FTE Add-on

Monthly

$2,321

Direct Care 0.75 FTE Add-on

Monthly

$3,482

Direct Care 1.0 FTE Add-on

Monthly

$4,643

(e) Sexual and Domestic Violence Services. Terms used in 101 CMR 433.03(4)(i) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 429.02: Definitions.

Service/Program

Unit of Service

Rate

Domestic Violence Community-based Services

.25 Direct Care FTE

$1,952

Child Exposed to Domestic Violence Services

.25 Direct Care FTE

$2,097

Supervised Visitation Services

.25 Direct Care FTE

$1,990

Sexual and Domestic Violence Equity Services

.25 Direct Care FTE

$1,952

Sexual and Domestic Violence Equity Legal Services

.25 Direct Care FTE

$3,028

Intimate Partner Abuse Education Services

Per Cohort

$2,658

Intimate Partner Abuse Education Services - Outreach and Development

Monthly

$443

Rape Crisis Centers - Dual Agency Tier 1

Monthly

$67,141

Rape Crisis Centers - Dual Agency Tier 2

Monthly

$58,974

Rape Crisis Centers - Dual Agency Tier 3

Monthly

$50,807

Rape Crisis Centers - Dual Agency Tier 4

Monthly

$42,640

Rape Crisis Centers - Dual Agency Tier 5

Monthly

$34,473

Rape Crisis Centers - Dual Agency Tier 6

Monthly

$26,306

Rape Crisis Centers - Dual Agency Tier 7

Monthly

$18,139

Rape Crisis Centers - Dual Agency Tier 8

Monthly

$9,972

Rape Crisis Centers - Stand-alone Agency Tier 1

Monthly

$70,328

Rape Crisis Centers - Stand-alone Agency Tier 2

Monthly

$61,771

Rape Crisis Centers - Stand-alone Agency Tier 3

Monthly

$53,214

Rape Crisis Centers - Stand-alone Agency Tier 4

Monthly

$44,658

Rape Crisis Centers - Stand-alone Agency Tier 5

Monthly

$36,101

Rape Crisis Centers - Stand-alone Agency Tier 6

Monthly

$27,544

Rape Crisis Centers - Stand-alone Agency Tier 7

Monthly

$18,987

Rape Crisis Centers - Stand-alone Agency Tier 8

Monthly

$10,430

Rape Crisis Satellite Center Add-on

Hourly

$40.40

Rape Crisis Direct Care 0.25 FTE Add-on

Monthly

$1,952

(f) Program of Assertive Community Treatment. Terms used in 101 CMR 433.03(4)(j) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 430.02: Definitions.

Service/Program

Unit of Service

Rate

Program of Assertive Community Treatment - PACT50

Enrollment Day

$54.02

Program of Assertive Community Treatment - PACT80

Enrollment Day

$49.83

Program of Assertive Community Treatment - Forensic PACT

Enrollment Day

$78.54

Program of Assertive Community Treatment - Forensic GLE

Bed Day

$323.39

(g) Certain Respite Services. Terms used in 101 CMR 433.03(4)(k) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 431.02: Definitions.

Service/Program

Unit of Service

Rate

Respite - A

Month

$60,629

Respite - B

Month

$83,628

Respite - C

Month

$172,054

Respite - Peer Model

Month

$43,271

Respite - Site Only

Per Diem

$262.40

Respite - Mobile Only

Per Diem

$130.52

(h) Lead Agency Services. Terms used in 101 CMR 433.03(4)(l) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 432.02: Definitions.

Service/Program

Unit of Service

Rate

Lead Agency Tier 1

Month

$26,181

Lead Agency Tier 2

Month

$31,772

Lead Agency Tier 3

Month

$37,060

Lead Agency Tier 4

Month

$40,706

Lead Agency Tier 5

Month

$55,781

Lead Agency Tier 6

Month

$73,749

Case Manager/Education Coordinator 0.50 FTE Add-on

Month

$2,916

Case Manager/Education Coordinator 1.0 FTE Add-on

Month

$5,832

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