101-cmr-348.doc - Final Adoption 101 CMR EXECUTIVE OFFICE...

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Final Adoption April 30, 2014 101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES 101 CMR 348:00 DAY HABILITATION PROGRAM SERVICES Section 348.01: General Provisions 348.02: General Definitions 348.03: General Rate Provisions 348.04: Filing and Reporting Requirements 348.05: Severability 348.01: General Provisions (1) Scope, Purpose and Effective Date . 101 CMR 348.00 governs the payment rates for day habilitation services rendered to publicly aided individuals effective February 1, 2014. The rates set forth in 101 CMR 348.00 also apply to day habilitation services governed by 130 CMR 419.000 and other comparable programs. (2) Coverage . The payment rates in 101 CMR 348.00 shall constitute full compensation for day habilitation services provided to publicly aided individuals as well as full compensation for any administration and professional supervision associated with providing the services. (3) Coding Updates and Corrections . EOHHS may publish procedure code updates and corrections in the form of an Administrative Bulletin. The publication of such updates and corrections will list: (a) codes for which only the code numbers change, with the corresponding cross references between existing and new codes; (b) codes for which the code number remains the same but the description has changed (c) deleted codes for which there are no corresponding new codes; and (d) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (I.C.) reimbursement for these new codes until appropriate rates can be developed. (4) Administrative Bulletins . EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 348.00. 1
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Final Adoption April 30, 2014 101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES 101 CMR 348:00 DAY HABILITATION PROGRAM SERVICES (5) Disclaimer of Authorization of Services . 101 CMR 348.00 is neither authorization for nor approval of the substantive programs for which rates are determined pursuant to 101 CMR 348.00. Governmental Units that purchase care are responsible for the definition, authorization, and approval of care and services extended to publicly aided individuals. Information about substantive program requirements must be obtained from purchasing Governmental Units. 348.02: General Definitions Meaning of Terms . Terms used in 101 CMR 348.00, unless the context requires otherwise, shall have the meanings ascribed in 101 CMR 348.02. Approved Rates . The rates of payment that have been certified by EOHHS and filed with the Secretary of the Commonwealth. These rates govern payment for services under 101 CMR 348.00. Center . The Center for Health Information and Analysis established under M.G.L. c. 12C. Client Severity Profile . A form measuring functional level that is used to determine the applicable MassHealth payment rate category for a day habilitation client. The client is rated as low, moderate, or high need based on his or her score on the Client Severity Profile form. .
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