Rates for Certain Respite Services

Final Adoption Date Published in Mass Register: September 26, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 431.00: RATES FOR CERTAIN RESPITE SERVICES

Section

431.01: General Provisions 431.02: Definitions 431.03: Rate Provisions 431.04: Filing and Reporting Requirements 431.05: Severability

431.01: General Provisions

(1) Scope. .00 governs the payment rates for certain respite services purchased by governmental units including the Department of Mental Health.

(2) Applicable Dates of Service. Rates contained within .00 apply for dates of service provided on or after July 1, 2025.

(3) Disclaimer of Authorization of Services. .00 is neither authorization for nor approval of the services for which rates are determined pursuant to .00. Governmental units that purchase the services described in .00 are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of .00.

431.02: Definitions

As used in .00, unless the context requires otherwise, terms have the meanings in .02.

Client. An individual who receives certain respite services purchased by a governmental unit.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

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

Provider. Any individual, group, partnership, trust, corporation, or other legal entity that offers services for purchase by a governmental unit and that meets the conditions of purchase or licensure that have been or may be adopted by a purchasing governmental unit.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

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Final Adoption Date Published in Mass Register: September 26, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

.00: RATES FOR CERTAIN RESPITE SERVICES

Respite Services. These services provide temporary short-term, community-based clinical and rehabilitative services that enable an individual to live in the community as fully and independently as possible. Services are strength-based and person-centered in supporting clients to maintain, enter, or return to permanent living situations and are available in both site-based and mobile settings.

431.03: Rate Provisions

(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) Administrative Adjustment for Extraordinary Circumstances. A method whereby, subject to availability of funds, a purchasing governmental unit may provide additional resource allocations to a qualified provider in response to unusual and unforeseen circumstances that substantially increase the cost of service delivery in ways not contemplated in the development of current rates. It must be demonstrated that such cost increases gravely threaten the stability of service provision such that client or consumer access to necessary services is at risk. The purchasing governmental unit will evaluate the need for the administrative adjustment, determine whether funding is available, and convey that information to EOHHS for review to determine the amount of any adjustment.

(5) Approved Rates. The approved rate is the lower of the provider’s charge or amount accepted as payment from another payer or the rate listed in .03.

Service Model Unit of Service Rate A Month $84,951 B Month $117,270 C Month $238,563 Respite Peer Model Month $56,676 Site Only Per Diem $341.24 Mobile Only Per Diem $169.61

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Final Adoption Date Published in Mass Register: September 26, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

.00: RATES FOR CERTAIN RESPITE SERVICES

431.04: Filing and Reporting Requirements

(1) General Provisions. (a) Accurate Data. All reports, schedules, additional information, books, and records that are filed or made available to EOHHS must be certified under pains and penalties of perjury as true, correct, and accurate by the executive director or chief financial officer of the provider. (b) Examination of Records. Each provider must make available to EOHHS or the purchasing governmental unit upon request all records relating to its reported costs, including costs of any entity related by common ownership or control.

(2) Required Reports. Each provider must file (a) an annual Uniform Financial Statements and Independent Auditor's Report completed in accordance with the filing requirements of 808 CMR 1.00: Compliance, Reporting and Auditing for Human and Social Services; (b) any cost report supplemental schedule as issued by EOHHS; and (c) any additional information requested by EOHHS within 21 days of a written request.

(3) Penalty for Noncompliance. The purchasing governmental unit may impose a penalty in the amount of up to 15% of its payments to any provider that fails to submit required information. The purchasing governmental unit will notify the provider in advance of its intention to impose a penalty under .04(3).

431.05: Severability

The provisions of .00 are severable. If any provision of .00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of .00 or application of those provisions to applicable individuals, entities, or circumstances.

REGULATORY AUTHORITY

.00: M.G.L. c. 118E.

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