Code of Massachusetts Regulations
114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY
Title 114.5 CMR 4.00 - Rates For Certain Social, Rehabilitation And Health Care Consultant Services
Section 4.02 - Definitions

Approved Rate. The rate per service unit approved by the Division, or, in the case of cost reimbursement, the maximum obligation approved by the Division.

Client Resources. Revenue received in cash or kind from publicly aided clients to defray all or a portion of the cost of the service. These may include supplemental security income received by the operating agency to defray the room and board expense of residential clients, clients' food stamps, or payments made by clients according to ability to pay or sliding fee scale.

Consultant Services. Services rendered by individuals who provide social, rehabilitation, or healthcare related services to clients when the services are purchased directly by governmental units. These do not include consultant services purchased by a provider in order to deliver services purchased by a governmental unit.

Cost Reimbursement. A purchase arrangement, where the provider bills the purchasing governmental unit for costs incurred up to the stated maximum obligation.

Division. The Division of Health Care Finance and Policy established under M.G.L.c. 118G

Established Charge. The lowest fee that is charged by the provider to the general public or any third party payor other than a governmental unit, for the provision of one service unit. Fees which are based upon the purchaser's ability to pay, as in the case of a sliding fee scale, and fees which are subject to Division review and approval shall not be deemed to be established charges.

Fixed Costs. Those costs, as determined by the Division, which are independent of inflation and the level of occupancy include, but are not limited to interest associated with long-term debt, depreciation, insurance on buildings and equipment, real estate taxes, lease or rental payments, and the non-income related portion of the Massachusetts corporate excise tax.

Governmental Unit. The Commonwealth of Massachusetts and any board, commission, department, division, or agency of the Commonwealth of Massachusetts and any school district or other political subdivision of the Commonwealth of Massachusetts.

Maximum Obligation. The maximum dollar amount by which a purchasing governmental unit(s) may obligate the Commonwealth under a contract for the purchase of health care services.

Out-of-State Governmental Unit. A state other than the Commonwealth of Massachusetts and any board, commission, department, division, or agency of that state or the government of the United States.

Out-of-State Provider. An individual, group or legal entity that operates or will operate a program of health care services which care and services have been or will be provided outside the Commonwealth of Massachusetts.

Program. The organization and delivery of a predetermined mix or configuration of health services designed to assist clients in achieving a common objective, alleviate a common problem or meet a common need.

Provider. Any person, partnership, corporation, trust or other entity providing health care services and meeting such conditions of participation as have been or may be adopted from time to time by a governmental unit purchasing such services.

Prudent Buyer Concept. An assumption that any amount paid for goods and services which is above the market price or the amount paid by comparable providers is unreasonable.

Publicly Assisted Client. A person who receives care in a program for which a governmental unit is in whole or in part liable for such care under a statutory program of financial assistance.

Related Party. A person or organization which is associated or affiliated with or has control of or is controlled by the provider or is related to the provider or any director, stockholder, trustee, partner or administrator of the provider by common ownership or control or in a manner specified in sections 267(b) and (c) of the Internal Revenue Code of 1954 as amended provided, however, that 10% shall be the operative factor as set out in sections 267(b)(2)(8)(10)(11) and (12) and f (1)(A) and provided further that the definition of "family members" found in section 267(c)(4) of said code shall include, for the purposes of 114. 5 CMR 4.00, spouses and lineal descendants of the individual's brothers and sisters, brothers and sisters of the individual's spouse as well as spouses and lineal descendants of same and lineal ancestors of the individual's spouse.

Restricted Funds. Funds which have been restricted as to application by the donor or grantor, or which are generated from funds so restricted. Funds which have been restricted as to application by the board of the provider are not restricted funds.

Service Unit. A unit of care as determined by the purchasing governmental unit.