Code of Massachusetts Regulations
114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY
Title 114.1 CMR 39.00 - CHRONIC AND REHABILITATION PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS
Section 39.09 - Fee for Residential Alcoholism Treatment Programs

Universal Citation: 114.1 CMR 39.00 MA Code of Regs 39.09

Current through Register 1531, September 27, 2024

(1) Fee. The fee for a residential alcoholism treatment program shall be equal to the actual charge times the Payment on Account Factor most recently approved by the Commission pursuant to 114. 1 CMR 28.00 or 114.1 CMR 37.00, unless adjusted as described below, or until it is superseded by a new regulation, or unless a lesser amount is established by any valid order of a court of competent jurisdiction upon a written finding of indigence or in ability to pay pursuant to St. 1 9 8 2 , c. 3 9 3 . The Commonwealth shall pay to the hospital any difference between the payment made by the individual served and the approved charge times the Payment on Account Factor.

(a) The Payment on Account Factor shall be adjusted downward prospectively, pro-rated for months remaining in the rate year, if the charge per visit as reported in the DHCFP-450 Form increases beyond the FY 1996 to FY 1997 inflation factor calculated pursuant to the methodology in 114. 1 CMR 39.05(2)(c)2..

(b) Determination of the Medicaid Payment on Account Factor shall be made in accordance with the information filed on the DHCFP-450 Form.

(2) Reimbursement as Full Payment. Each hospital which operates a residential alcoholism treatment program shall, as a condition to receipt of payment, accept reimbursement at rates established by the Commission, subject to appellate rights set forth in M.G.L. c. 118G, as full payment and discharges of all obligations of individuals served by such programs. There shall be no duplication or supplementation of payment.

(3) Eligible Providers. Only providers receiving specific permission from the Division of Alcoholism, Massachusetts Department of Public Health may receive reimbursement for residential alcoholism treatment programs under 114. 1 CMR 39.00. Costs associated with residential alcoholism treatment program operating without such permission shall not be included in allowed operating cost.

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