Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 445.00
Section 445.03 - Rate Provisions
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 provider must, as a condition of acceptance of payment by a purchasing agency for services provided to a client, accept the payment rates established by 101 CMR 445.00 as full payment and discharge of all obligations for the services provided. The provider may not seek additional or supplemental payment from clients or other third parties for services for which rates are established by 101 CMR 445.00. If a provider receives any client funds or third-party payments for services provided to a client, the purchasing agency's obligation for services to the client will be offset by the amount received.
|
Service Description |
Code |
Unit |
Rate |
|
Adult Day Health - Basic Level of Care |
S5102 |
Per Diem |
$87.74 |
|
Adult Day Health - Complex Level of Care |
S5102 TG |
Per Diem |
$111.10 |
|
Adult Day Health - Basic Level of Care |
S5100 |
Per 15 Min. |
$3.65 |
|
Adult Day Health - Basic Level of Care |
S5101 |
Per 3 Hours |
$43.85 |
|
Adult Day Health - Complex Level of Care |
S5100 TG |
Per 15 Min. |
$4.62 |
|
Adult Day Health - Complex Level of Care |
S5101 TG |
Per 3 Hours |
$55.44 |
|
Day Habilitation - Skills training and development, per 15 minutes (community program, low need) |
H2014 |
Per 15 Min. |
$4.09 |
|
Day Habilitation - Skills training and development, per 3 hours (community program, low need) |
S5101 |
Per 3 Hours |
$49.06 |
|
Day Habilitation - Skills training and development, per 6 hours (community program, low need) |
S5102 |
Per 6 Hours |
$98.11 |
|
Day Habilitation - Skills training and development per 15 minutes, intermediate level of care (community program, moderate need) |
H2014-TF |
Per 15 Min. |
$4.62 |
|
Day Habilitation - Skills training and development per 3 hours, intermediate level of care (community program, moderate need) |
S5101-TF |
Per 3 Hours |
$55.44 |
|
Day Habilitation - Skills training and development per 6 hours, intermediate level of care (community program, moderate need) |
S5012-TF |
Per 6 Hours |
$111.10 |
|
Day Habilitation - Skills training and development, per 15 minutes, complex/high tech level of care (community program, high need) |
H2014-TG |
Per 15 Min. |
$5.99 |
|
Day Habilitation - Skills training and development, per 3 hours complex/high tech level of care (community program, high need) |
S5101-TG |
Per 3 Hours |
$71.90 |
|
Day Habilitation - Skills training and development, per 6 hours complex/high tech level of care (community program, high need) |
S5102-TG |
Per 6 Hours |
$143.81 |
|
Day Habilitation - Skills training and development per 15 minutes (nursing facility, one-to-two or one to three staffing level) |
H2014-U1 |
Per 15 Min. |
$5.77 |
|
Day Habilitation - Skills training and development per 3 hours (nursing facility, one-to-two or one to three staffing level) |
S5101-U1 |
Per 3 Hours |
$69.22 |
|
Day Habilitation - Skills training and development per 6 hours (nursing facility, one-to-two or one to three staffing level) |
S5102-U1 |
Per 6 Hours |
$138.43 |
|
Day Habilitation - Skills training and development, per 15 minutes (nursing facility, one-to-one staffing level) |
H2014-U2 |
Per 15 Min. |
$10.40 |
|
Day Habilitation - Skills training and development, per 3 hours (nursing facility, one-to-one staffing level) |
S5101-U2 |
Per 3 Hours |
$124.82 |
|
Day Habilitation - Skills training and development, per 6 hours (nursing facility, one-to-one staffing level) |
S5102-U2 |
Per 6 Hours |
$249.65 |
|
Day Habilitation - Skills training and development, per 15 minutes, unusual procedural service, when the service(s) provided is greater than that usually listed for the listed procedure (supplemental staffing for nursing facility residents in community day habilitation) |
H2014-22 |
Per 15 Min. |
$4.77 |
|
Day Habilitation - Skills training and development, per 3 hours, unusual procedural service, when the service(s) provided is greater than that usually listed for the listed procedure (supplemental staffing for nursing facility residents in community day habilitation) |
S5101-22 |
Per 3 Hours |
$57.29 |
|
Day Habilitation - Skills training and development, per 6 hours, unusual procedural service, when the service(s) provided is greater than that usually listed for the listed procedure (supplemental staffing for nursing facility residents in community day habilitation) |
S5102-22 |
Per 6 Hours |
$114.58 |
|
Day Habilitation - Nonemergency transportation; encounter/trip (used only when serving four or more individuals in a nursing facility) |
T2003 |
Per Trip/ Encounter |
$5.11 |
|
Day Services - HCBS (ABI/MFP) |
Multiple |
Per Diem |
$147.14 |
|
Day Services - HCBS (ABI/MFP) - partial day |
Multiple |
Per 3 Hours |
$73.57 |
|
Individual Supported Employment |
Multiple |
Per 15 Min. |
$18.16 |
|
Prevocational Services |
T2019 |
Per 15 Min. |
$13.09 |
|
Service Description |
Code |
Unit |
Rate |
|
Adult Day Health - Basic Level of Care |
S5102 |
Per Diem |
$78.34 |
|
Adult Day Health - Complex Level of Care |
S5102 TG |
Per Diem |
$99.20 |
|
Adult Day Health - Basic Level of Care |
S5100 |
Per 15 Min. |
$3.26 |
|
Adult Day Health - Basic Level of Care |
S5101 |
Per 3 Hours |
$39.15 |
|
Adult Day Health - Complex Level of Care |
S5100 TG |
Per 15 Min. |
$4.13 |
|
Adult Day Health - Complex Level of Care |
S5101 TG |
Per 3 Hours |
$49.50 |
|
Day Habilitation - Skills training and development, per 15 minutes (community program, low need) |
H2014 |
Per 15 Min. |
$3.65 |
|
Day Habilitation - Skills training and development, per 3 hours (community program, low need) |
S5101 |
Per 3 Hours |
$43.80 |
|
Day Habilitation - Skills training and development, per 6 hours (community program, low need) |
S5102 |
Per 6 Hours |
$87.60 |
|
Day Habilitation - Skills training and development per 15 minutes, intermediate level of care (community program, moderate need) |
H2014-TF |
Per 15 Min. |
$4.13 |
|
Day Habilitation - Skills training and development per 3 hours, intermediate level of care (community program, moderate need) |
S5101-TF |
Per 3 Hours |
$49.50 |
|
Day Habilitation - Skills training and development per 6 hours, intermediate level of care (community program, moderate need) |
S5102-TF |
Per 6 Hours |
$99.00 |
|
Day Habilitation - Skills training and development, per 15 minutes, complex/high tech level of care (community program, high need) |
H2014-TG |
Per 15 Min. |
$5.35 |
|
Day Habilitation - Skills training and development, per 3 hours complex/high tech level of care (community program, high need) |
S5101-TG |
Per 3 Hours |
$64.20 |
|
Day Habilitation - Skills training and development, per 6 hours complex/high tech level of care (community program, high need) |
S5102-TG |
Per 6 Hours |
$128.40 |
|
Day Habilitation - Skills training and development per 15 minutes (nursing facility, one-to-two or one to three staffing level) |
H2014-U1 |
Per 15 Min. |
$5.15 |
|
Day Habilitation - Skills training and development per 3 hours (nursing facility, one-to-two or one to three staffing level) |
S5101-U1 |
Per 3 Hours |
$61.80 |
|
Day Habilitation - Skills training and development per 6 hours (nursing facility, one-to-two or one to three staffing level) |
S5102-U1 |
Per 6 Hours |
$123.60 |
|
Day Habilitation - Skills training and development, per 15 minutes (nursing facility, one-to-one staffing level) |
H2014-U2 |
Per 15 Min. |
$9.29 |
|
Day Habilitation - Skills training and development, per 3 hours (nursing facility, one-to-one staffing level) |
S5101-U2 |
Per 3 Hours |
$111.45 |
|
Day Habilitation - Skills training and development, per 6 hours (nursing facility, one-to-one staffing level) |
S5102-U2 |
Per 6 Hours |
$222.90 |
|
Day Habilitation - Skills training and development, per 15 minutes, unusual procedural service, when the service(s) provided is greater than that usually listed for the listed procedure (supplemental staffing for nursing facility residents in community day habilitation) |
H2014-22 |
Per 15 Min. |
$4.26 |
|
Day Habilitation - Skills training and development, per 3 hours, unusual procedural service, when the service(s) provided is greater than that usually listed for the listed procedure (supplemental staffing for nursing facility residents in community day habilitation) |
S5101-22 |
Per 3 Hours |
$51.15 |
|
Day Habilitation - Skills training and development, per 6 hours, unusual procedural service, when the service(s) provided is greater than that usually listed for the listed procedure (supplemental staffing for nursing facility residents in community day habilitation) |
S5102-22 |
Per 6 Hours |
$102.30 |
|
Day Habilitation - Nonemergency transportation; encounter/trip (used only when serving four or more individuals in a nursing facility) |
T2003 |
Per Trip/ Encounter |
$4.56 |
|
Day Services - HCBS (ABI/MFP) |
Multiple |
Per Diem |
$131.38 |
|
Day Services - HCBS (ABI/MFP) - partial day |
Multiple |
Per 3 Hours |
$65.69 |
|
Individual Supported Employment |
Multiple |
Per 15 Min. |
$16.21 |
|
Prevocational Services |
T2019 |
Per 15 Min. |
$11.69 |
|
Service Description |
Code |
Unit |
Rate (Refer to the rate listed in the cited regulation.) |
|
Adult Day Health - Basic Level of Care |
S5102 |
Per Diem |
101 CMR 310.00: Adult Day Health Services |
|
Adult Day Health - Complex Level of Care |
S5102 TG |
Per Diem |
|
|
Adult Day Health - Basic Level of Care |
S5100 |
Per 15 Min. |
101 CMR 310.00: Adult Day Health Services |
|
Adult Day Health - Basic Level of Care |
S5101 |
Per 3 Hours |
|
|
Adult Day Health - Complex Level of Care |
S5100 TG |
Per 15 Min. |
|
|
Adult Day Health - Complex Level of Care |
S5101 TG |
Per 3 Hours |
|
|
Day Habilitation - Skills training and development, per 15 minutes (community program, low need) |
H2014 |
Per 15 Min. |
101 CMR 348.00: Day Habilitation Program Services |
|
Day Habilitation - Skills training and development, per 3 hours (community program, low need) |
S5101 |
Per 3 Hours |
|
|
Day Habilitation - Skills training and development, per 6 hours (community program, low need) |
S5102 |
Per 6 Hours |
|
|
Day Habilitation - Skills training and development per 15 minutes, intermediate level of care (community program, moderate need) |
H2014-TF |
Per 15 Min. |
|
|
Day Habilitation - Skills training and development per 3 hours, intermediate level of care (community program, moderate need) |
S5101-TF |
Per 3 Hours |
|
|
Day Habilitation - Skills training and development per 6 hours, intermediate level of care (community program, moderate need) |
S5102-TF |
Per 6 Hours |
|
|
Day Habilitation - Skills training and development, per 15 minutes, complex/high tech level of care (community program, high need) |
H2014-TG |
Per 15 Min. |
|
|
Day Habilitation - Skills training and development, per 3 hours complex/high tech level of care (community program, high need) |
S5101-TG |
Per 3 Hours |
|
|
Day Habilitation - Skills training and development, per 6 hours complex/high tech level of care (community program, high need) |
S5102-TG |
Per 6 Hours |
|
|
Day Habilitation - Skills training and development per 15 minutes (nursing facility, one-to-two or one to three staffing level) |
H2014-U1 |
Per 15 Min. |
|
|
Day Habilitation - Skills training and development per 3 hours (nursing facility, one-to-two or one to three staffing level) |
S5101-U1 |
Per 3 Hours |
|
|
Day Habilitation - Skills training and development per 6 hours (nursing facility, one-to-two or one to three staffing level) |
S5102-U1 |
Per 6 Hours |
|
|
Day Habilitation - Skills training and development, per 15 minutes (nursing facility, one-to-one staffing level) |
H2014-U2 |
Per 15 Min. |
|
|
Day Habilitation - Skills training and development, per 3 hours (nursing facility, one-to-one staffing level) |
S5101-U2 |
Per 3 Hours |
101 CMR 348.00: Day Habilitation Program Services |
|
Day Habilitation - Skills training and development, per 6 hours (nursing facility, one-to-one staffing level) |
S5102-U2 |
Per 6 Hours |
|
|
Day Habilitation - Skills training and development, per 15 minutes, unusual procedural service, when the service(s) provided is greater than that usually listed for the listed procedure (supplemental staffing for nursing facility residents in community day habilitation) |
H2014-22 |
Per 15 Min. |
|
|
Day Habilitation - Skills training and development, per 3 hours, unusual procedural service, when the service(s) provided is greater than that usually listed for the listed procedure (supplemental staffing for nursing facility residents in community day habilitation) |
S5101-22 |
Per 3 Hours |
|
|
Day Habilitation - Skills training and development, per 6 hours, unusual procedural service, when the service(s) provided is greater than that usually listed for the listed procedure (supplemental staffing for nursing facility residents in community day habilitation) |
S5102-22 |
Per 6 Hours |
|
|
Day Habilitation - Non-emergency transportation; encounter/trip (used only when serving four or more individuals in a nursing facility) |
T2003 |
Per Trip/ Encounter |
|
|
Day Services - HCBS (ABI/MFP) |
Multiple |
Per Diem |
101 CMR 359.00: Rates for Home and Communitybased Services Waivers |
|
Day Services - HCBS (ABI/MFP) - partial day |
Multiple |
Per 3 Hours |
|
|
Individual Supported Employment |
Multiple |
Per 15 Min. |
101 CMR 419.00: Rates for Supported Employment Services |
|
Prevocational Services |
T2019 |
Per 15 Min. |
101 CMR 359.00: Rates for Home and Communitybased Services Waivers |
