Rates for Homeless Medical Respite Services

Final Regulation Date published in Mass. Register: January 3, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 321.00: RATES FOR HOMELESS MEDICAL RESPITE SERVICES

Section

321.01: General Provisions 321.02: Definitions 321.03: Rate Provisions 321.04: Filing and Reporting Requirements 321.05: Severability

321.01: General Provision

(1) Scope and Purpose. .00 governs the rates for all governmental units and worker’s compensation insurers for homeless medical respite services provided by eligible providers.

(2) Applicable Dates of Service. Rates contained in .00 apply for dates of service provided on or after January 3, 2025, unless otherwise indicated.

(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 and understanding of substantive provisions of .00.

321.02: Definitions

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

Eligible Provider. A medical respite setting that meets the conditions of participation that have been adopted by a governmental unit purchasing medical respite services established under 130 CMR 458.000: Homeless Medical Respite Services.

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

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

Homeless Medical Respite or Medical Respite. As defined in 130 CMR 458.402: Homeless Medical Respite or Medical Respite.

Medical Leave of Absence (MLOA). As defined in .402: Medical Leave of Absence (MLOA).

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Final Regulation Date published in Mass. Register: January 3, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

.00: RATES FOR HOMELESS MEDICAL RESPITE SERVICES

Nonmedical Leave of Absence (NMLOA). As defined in .402: Nonmedical Leave of Absence (NMLOA).

Per Diem. A unit of payment that refers to a billable day in which the member is enrolled in the program.

Post-hospitalization Medical Respite. As defined in .402: Post-hospitalization Medical Respite.

Pre-procedure Medical Respite. As defined in .402: Pre-procedure Medical Respite.

Publicly Aided Individual. A person who receives health care and services for which a governmental unit is in whole or in part liable under a statutory program.

321.03: Rate Provisions

(1) Rates as Payment in Full. The rates under .00 constitute payment in full for homeless medical respite services provided by eligible providers to publicly aided and industrial accident patients, including full compensation for necessary administration and professional supervision associated with patient care.

(2) Rates of Payment. Payment rates for medical respite program services are set forth in 101 CMR 321.03(2).

Code Rate Service Description H0043-UA $255.44 Supported housing, per diem (comprehensive pre-procedure medical respite services, short-term pre procedure housing) H0043-UB $255.44 Supported housing, per diem (comprehensive post-hospitalization medical respite services, short-term post hospitalization housing) H0043-UC $255.44 Supported housing, per diem (comprehensive post-hospitalization medical respite services medical leave of absence) Supported housing, per diem (comprehensive post hospitalization medical H0043-UD $255.44 respite services non-medical leave of absence – planned) Supported housing, per diem (comprehensive post hospitalization medical H0043-U1 $255.44 respite services non-medical leave of absence – unplanned)

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Final Regulation Date published in Mass. Register: January 3, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

.00: RATES FOR HOMELESS MEDICAL RESPITE SERVICES

321.04: Filing and Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements.

(2) 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(2).

321.05: 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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