101 CMR 359.00 — Rates for Home- and Community-Based Services Waivers

cmr-101-359.00101 CMR 359.00Regulation

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Final Adoption Date Published in Mass. Register: November 07, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 359.00: RATES FOR HOME- AND COMMUNITY-BASED SERVICES WAIVERS

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Section

359.01: General Provisions 359.02: Definitions 359.03: Rate Provisions 359.04: Filing and Reporting Requirements 359.05: Severability

101 CMR 359.00 Rates for Home- and Community-Based Services Waivers

359.01 General Provisions

359.01: General Provisions

(1) Scope. 101 CMR 359.00 governs the payment rates for services in four Home- and Community- based Services (HCBS) Waivers purchased by a governmental unit. The four HCBS Waivers are: Acquired Brain Injury Non-residential Habilitation (ABI-N) Waiver, Acquired Brain Injury Residential Habilitation (ABI-RH) Waiver, Moving Forward Plan Community Living (MFP-CL) Waiver, and Moving Forward Plan Residential Supports (MFP-RS) Waiver. Listed in 101 CMR 359.01(1)(a) through (d) are the waiver services available in each waiver. (a) ABI-N Waiver Services:

  1. Adult Companion
  2. Assistive Technology
  3. Chore Services
  4. Community-based Day Supports
  5. Community Family Training
  6. Community Behavioral Health Support & Navigation
  7. Day Services
  8. Home Accessibility Adaptations
  9. Home Delivered Meals
  10. Home Health Aide
  11. Homemaker
  12. Independent Living Supports
  13. Individual Support and Community Habilitation
  14. Laundry
  15. Occupational Therapy
  16. Orientation and Mobility Services
  17. Peer Support
  18. Personal Care
  19. Physical Therapy
  20. Prevocational Services
  21. Respite
  22. Shared Home Supports
  23. Skilled Nursing
  24. Specialized Medical Equipment
  25. Speech Therapy
  26. Supported Employment

Final Adoption Date Published in Mass. Register: November 07, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 359.00: RATES FOR HOME- AND COMMUNITY-BASED SERVICES WAIVERS

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  1. Supportive Home Care Aide

  2. Transitional Assistance Services

  3. Vehicle Modification

  4. Transportation (b) ABI-RH Waiver Services:

  5. Assisted Living Services

  6. Assistive Technology

  7. Community-based Day Supports

  8. Community Behavioral Health Support & Navigation

  9. Day Services

  10. Home Accessibility Adaptations (available only in Shared Living – 24-hour Supports)

  11. Individual Support and Community Habilitation

  12. Occupational Therapy

  13. Orientation and Mobility Services

  14. Peer Support

  15. Physical Therapy

  16. Prevocational Services

  17. Residential Family Training

  18. Residential Habilitation

  19. Shared Living – 24-Hour Supports

  20. Skilled Nursing

  21. Specialized Medical Equipment

  22. Speech Therapy

  23. Supported Employment

  24. Transitional Assistance Services

  25. Transportation (c) MFP-CL Waiver Services:

  26. Adult Companion

  27. Assistive Technology

  28. Chore Services

  29. Community-based Day Supports

  30. Community Family Training

  31. Community Behavioral Health Support and Navigation

  32. Day Services

  33. Home Accessibility Adaptations

  34. Home Delivered Meals

  35. Home Health Aide

  36. Homemaker

  37. Independent Living Supports

  38. Individual Support and Community Habilitation

  39. Laundry

  40. Occupational Therapy

Final Adoption Date Published in Mass. Register: November 07, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 359.00: RATES FOR HOME- AND COMMUNITY-BASED SERVICES WAIVERS

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  1. Orientation and Mobility Services
  2. Peer Support
  3. Personal Care
  4. Physical Therapy
  5. Prevocational Services
  6. Respite
  7. Shared Home Supports
  8. Skilled Nursing
  9. Specialized Medical Equipment
  10. Speech Therapy
  11. Supported Employment
  12. Supportive Home Care Aide
  13. Transportation
  14. Transitional Assistance Services
  15. Vehicle Modification (d) MFP-RS Waiver Services:
  16. Assisted Living Services
  17. Assistive Technology
  18. Community-based Day Supports
  19. Community Behavioral Health Support and Navigation
  20. Day Services
  21. Home Accessibility Adaptations (available only in Shared Living – 24-hour Supports)
  22. Individual Support and Community Habilitation
  23. Occupational Therapy
  24. Orientation and Mobility Services
  25. Peer Support
  26. Physical Therapy
  27. Prevocational Services
  28. Residential Family Training
  29. Residential Habilitation
  30. Shared Living – 24-hour Supports
  31. Skilled Nursing
  32. Specialized Medical Equipment
  33. Speech Therapy
  34. Supported Employment
  35. Transitional Assistance Services
  36. Transportation

(2) Applicable Dates of Service. Rates contained in 101 CMR 359.00 apply for dates of service on or after November 7, 2025.

(3) Disclaimer of Authorization of Services. 101 CMR 359.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 359.00. Governmental units that purchase MFP Waiver Services and/or ABI Waiver Services are responsible for the definition, authorization, and approval of services extended to participants.

Final Adoption Date Published in Mass. Register: November 07, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

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(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 359.00. (5) Coding Updates and Corrections. EOHHS may publish service code updates and corrections by administrative bulletin. Updates may reference coding systems including but not limited to the American Medical Association’s Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) maintained by the Centers for Medicare and Medicaid Services (CMS). 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) deleted codes for which there are no corresponding new codes; and (c) codes for entirely new services that require pricing. These codes will be paid on an individual consideration basis until rates are established.

359.02 Definitions

359.02: Definitions

As used in 101 CMR 359.00, unless the context requires otherwise, terms have the meanings in 101 CMR 359.02.

Acquired Brain Injury Home- and Community-based Service Waiver (ABI Waiver). Two Massachusetts home- and community-based services waivers approved by the Centers for Medicare and Medicaid Services (CMS) under the Social Security Act, § 1915(c) for persons with acquired brain injury who are transitioning from long-stay facilities. The two separate ABI Waivers each with different covered services and eligibility requirements, are the Acquired Brain Injury with Residential Habilitation (ABI-RH) Waiver and the Acquired Brain Injury Nonresidential Habilitation (ABI-N) Waiver.

Activities of Daily Living (ADL). Certain basic tasks required for daily living, including the ability to bathe, dress/undress, eat, toilet, transfer in and out of bed or chair, get around inside the home, and manage incontinence.

Adult Companion Service. Nonmedical care, supervision, and socialization provided to a participant. Companions may assist or supervise the participant with such light household tasks as meal preparation, laundry, and shopping.

Agency Rate. The fee for services performed by a person whose wage is paid by a corporation or partnership that is a MassHealth provider.

Assisted Living Services. Services consist of personal care and supportive services (homemaker, chore, personal care services, meal preparation) that are furnished to participants who reside in a qualified assisted living residence (ALR) that includes 24-hour on-site response capability to meet scheduled or unpredictable resident needs and to provide supervision, safety, and security. Services may also include social and recreational programs, and medication assistance (consistent with ALR certification and to the extent permitted under State law). Nursing and skilled therapy services are incidental rather than integral to the provision of Assisted Living Services.

Final Adoption Date Published in Mass. Register: November 07, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

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Intermittent skilled nursing services and therapy services may be provided to the extent allowed by applicable regulations.

Assistive Technology. This service has two components: Assistive Technology devices and Assistive Technology evaluation and training. These components are defined as follows: (a) Assistive Technology devices – an item, piece of equipment, or product system that is used to develop, increase, maintain, or improve functional capabilities of participants, and to support the participant to achieve goals identified in their Plan of Care. (b) Assistive Technology evaluation and training – the evaluation of the Assistive Technology needs of the participant, i.e. functional evaluation of the impact of the provision of appropriate Assistive Technology devices and services to the participant in the customary environment of the participant; the selection, customization and acquisition of Assistive Technology devices for participants; selection, design, fitting, customization, adaption, maintenance, repair, and/or replacement of Assistive Technology devices; coordination and use of necessary therapies, interventions, or services with Assistive Technology devices that are associated with other services contained in the Plan of Care; training and technical assistance for the participant, and, where appropriate, the family members, guardians, advocates, or authorized representatives of the participant; and training or technical assistance for professionals or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of participants. Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Chore. An unusual or infrequent household maintenance task that is needed to maintain the participant’s home in a clean, sanitary, and safe environment. Chore includes heavy household chores such as washing floors, windows, and walls; tacking down loose rugs and tiles; and moving heavy items of furniture in order to provide safe access and egress.

Community-based Day Supports (CBDS). A service designed to enable an individual to enrich his or her life and enjoy a full range of community activities by providing opportunities for developing, enhancing, and maintaining competency in personal and social interactions and community engagement. Community-based Day Supports uses a small group model to provide a flexible array of individualized supports through activities primarily in non-center-based settings, separate from the participant’s private residence or other residential living arrangement. The service may include career exploration, including assessment of interests through volunteer experiences or situational assessments; participant-driven experiences to support fuller participation in community life; development and support of activities of daily living and independent living skills, socialization experiences, and enhancement of interpersonal skills; and pursuit of personal interests and hobbies.

Community Family Training. A service designed to provide training and instruction about the treatment regimes, behavior plans, and the use of specialized equipment that support a participant in the community. Community family training may also include training in family leadership,

Final Adoption Date Published in Mass. Register: November 07, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

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support of self-advocacy, and independence for the family member. The service enhances the skills of the family to assist the waiver participant to function in the community and at home. Community Support and Navigation. A service that provides outreach and support services to enable participants to access and utilize clinical behavioral health treatment services and other supports. These services are staffed by paraprofessionals, supported by clinical supervision, and are designed to be maximally flexible in supporting participants to implement the goals in their plan of care and attain the skills and resources needed to successfully maintain community tenure. Such services may include: (a) Fostering empowerment, recovery, and wellness, including developing recovery strategies, identifying and assisting participants in accessing self-help options, and creating crisis prevention plans and relapse prevention plans; (b) Assisting participants in improving skills that enhance independence or accessing services to support them in enhancing independence; (c) Supporting service exploration and linkage; (d) Providing temporary assistance with transportation to essential medical and behavioral health appointments while transitioning to community-based transportation resources (e.g., public transportation resources, PT-1 forms, etc.) (e) Assisting with connecting the participant to necessary behavioral health and other health care services (including, as applicable, supporting initial engagement with coordination provided by the participant’s ACO or MCO); (f) Providing linkages to recovery-oriented peer supports and/or self-help supports and services; (g) Assisting with self-advocacy skills to improve communication and participation in treatment/service planning discussions and meetings; and (h) Collaborating with Emergency Services Programs/Mobile Crisis Intervention (ESP/MCIs) and/or outpatient providers, including working with ESP/MCIs to develop, revise, or utilize participant crisis prevention plans or safety plans.

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

Day Services. A structured, site-based, group program for participants that fosters community integration and offers assistance with the acquisition, retention, or improvement in self-help, socialization, and adaptive skills, and that takes place in a nonresidential setting separate from the participant’s private residence or other residential living arrangement. Services often include assistance to learn activities of daily living and functional skills; language and communication training; compensatory, cognitive and other strategies; interpersonal skills; prevocational skills; and recreational and socialization skills.

Employer Expense Component (EEC). The portion of the Self-directed Service rate that is designated for the mandated employer share of the Federal Insurance Contributions Act (FICA), federal and state unemployment taxes, Medicare, and Workers’ Compensation premiums.

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

Final Adoption Date Published in Mass. Register: November 07, 2025

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

Home Accessibility Adaptations. Physical modifications to the participant’s home that are necessary to ensure the health, welfare, and safety of the participant or that enable the participant to function with greater independence in the home.

Home- and Community-based Services (HCBS) Waiver. A federally approved program operated under the Social Security Act, § 1915(c) that authorizes the U.S. Secretary of Health and Human Services to grant waivers of certain Medicaid statutory requirements so that a state may furnish home- and community-based services to certain Medicaid beneficiaries who need a level of care that is provided in a hospital, nursing facility, or Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/ID). For purposes of 101 CMR 359.00, Home- and Community-based Service Waiver refers to the two ABI waivers and the two MFP waivers.

Home Delivered Meals. Services to a participant which provides well-balanced meals and maintains optimal nutritional and health status. Home Delivered Meals service includes the preparation, packaging, and delivery of meals by trained and supervised staff.

Home Health Aide. A person who performs certain personal care and other health-related services as described in 130 CMR 403.000: Home Health Agency.

Homemaker. A person who performs light housekeeping duties (for example, cooking, cleaning, laundry, and shopping) for the purpose of maintaining a household.

Independent Living Supports. A service that ensures 24-hour seven days per week access to supportive services for participants who have intermittent, scheduled, and unscheduled needs for various forms of assistance, but who do not require 24-hour supervision. It provides participants with services and supports in a variety of activities such as: ADLs and instrumental activities of daily living (IADLs), support and companionship, emotional support, and socialization. This service is provided by a site-based provider, and is available to participants who choose to reside in locations where a critical mass of individuals reside who require such support and where providers of such supports are available.

Individual Consideration (IC). Payment rates for certain services are designated as Individual Consideration (IC). Where IC rates are designated, the purchasing governmental unit will determine the appropriate payment rate in accordance with the following standards and criteria: (a) the amount of time required to complete the service or item; (b) the degree of skill required to complete the service or item; (c) the severity or complexity of the service or item; (d) the lowest price charged or accepted from any payer for the same or similar service or item, including, but not limited to any shelf price, sale price, advertised price, or other price reasonably obtained by a competitive market for the service or item; and (e) the established rates, policies, procedures, and practices of any other purchasing governmental unit in purchasing the same or similar services or items.

Final Adoption Date Published in Mass. Register: November 07, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

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Individual Provider (Self-employed Provider) Rate. The fee for services performed by a person that is a provider and is not paid a wage by another person or entity for services performed.

Individual Support and Community Habilitation. Regular or intermittent services designed to develop, maintain, and/or maximize the participant’s independent functioning in self-care, physical and emotional growth, socialization, communication, and vocational skills, to achieve objectives of improved health and welfare and to support the ability of the participant to establish and maintain a residence and live in the community.

Laundry. Services provided to a participant which includes pick up, washing, drying, folding, wrapping, and returning of laundry.

Moving Forward Plan Waivers (MFP Waivers). Two Massachusetts Home- and Community- based Services Waivers approved by the CMS under the Social Security Act, § 1915(c) for persons with disabilities who are transitioning from long-stay facilities. Massachusetts operates two separate MFP Waivers – the Moving Forward Plan Residential Supports (MFP-RS) waiver, and the Moving Forward Plan Community Living (MFP-CL) waiver, each with different covered services and eligibility requirements.

Non-agency Rate. The fee for services performed by individual providers (self-employed providers) or self-directed workers.

Occupational Therapy. Therapy services, including diagnostic evaluation and therapeutic intervention, designed to improve, develop, correct, rehabilitate, or prevent the worsening of functions that affect the activities of daily living that have been lost, impaired, or reduced as a result of acute or chronic medical conditions, congenital anomalies, or injuries. Occupational therapy programs are designed to improve quality of life by recovering competence and preventing further injury or disability, and to improve the individual’s ability to perform tasks required for independent functioning, so that the individual can engage in activities of daily living.

Orientation and Mobility Services. Services that teach an individual with vision impairment or legal blindness how to move or travel safely and independently in his or her home and community, and which includes assessment, training and education provided to participants, environmental evaluations, caregiver/direct care staff training on sensitivity to blindness/low vision, and information resource on community living for persons with vision impairment or legal blindness. Orientation and mobility services are tailored to the individual’s need and may extend beyond the home setting to other community settings as well as public transportation systems.

Participant. A MassHealth member determined by the MassHealth agency to be eligible for enrollment in one of the HCBS waivers, who chooses to receive HCBS waiver services, and for whom a service plan has been developed that includes one or more HCBS waiver services.

Final Adoption Date Published in Mass. Register: November 07, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

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Peer Support. Ongoing services and supports designed to assist participants to acquire, maintain, or improve the skills necessary to live in a community setting. This service provides supports necessary for the participant to develop the skills that enable them to become more independent, integrated into, and productive in their communities. The service enables the participant to retain or improve skills related to personal finance, health, shopping, use of community resources, community safety, and other adaptive skills needed to live in the community.

Personal Care. Services provided to a participant, which may include physical assistance, supervision, or cueing of participants, for the purpose of assisting the participant to accomplish activities of daily living (ADLs), including, but not limited to, eating, toileting, dressing, bathing, transferring, and ambulation.

Physical Therapy. Therapy services, including diagnostic evaluation and therapeutic intervention, designed to improve, develop, correct, rehabilitate, or prevent the worsening of physical functions that have been lost, impaired, or reduced as a result of acute or chronic medical conditions, congenital anomalies, or injuries. Physical therapy emphasizes a form of rehabilitation focused on treatment of dysfunctions involving neuromuscular, musculoskeletal, cardiovascular/pulmonary, or integumentary systems through the use of therapeutic interventions to optimize functioning levels.

Prevocational Services. A service that consists of a range of learning and experimental type activities that prepares a participant for paid or unpaid employment in an integrated, community setting. Services are not job-task oriented but instead, aimed at a generalized result (e.g., attention span, motor skills). The service may include teaching such concepts as attendance, task completion, problem solving, and safety as well as social skills training, improving attention span, and developing or improving motor skills. Basic skill-building activities are expected to specifically involve strategies to enhance a participant’s employability in integrated, community settings.

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. Residential Family Training. A service designed to provide training and instruction about treatment regimes, behavior plans, and the use of specialized equipment that supports the participant to participate in the community. Residential family training may also include training in family leadership, support of self-advocacy, and independence for their family member. The service enhances the skill of the family to assist the waiver participant to function in the community and at home when the waiver participant visits his or her family.

Residential Habilitation Room and Board. The amount paid by a governmental unit purchasing residential habilitation services for the costs of building, maintenance, upkeep, improvements, and meals, which are not covered as part of the Residential Habilitation Waiver service.

Final Adoption Date Published in Mass. Register: November 07, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 359.00: RATES FOR HOME- AND COMMUNITY-BASED SERVICES WAIVERS

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Residential Habilitation Service. Ongoing services and supports provided to a participant in a provider-operated residential setting that are designed to assist participants in acquiring, maintaining, or improving the skills necessary to live in a community setting. Residential habilitation provides participants with daily staff intervention including care, supervision, and skills training in activities of daily living, home management, and community integration in a qualified residential setting with 24-hour staffing. This service may include the provision of medical and health-care services that are integral to meeting the daily needs of participants.

Respite. Services provided to individuals unable to care for themselves; furnished on a short-term basis because of the absence or need for relief of unpaid caregivers. Self-directed Services. A model of service delivery in which a waiver participant has decision- making authority over certain aspects of the delivery of their care.

Self-directed Worker. Participants who choose to self-direct waiver services have the authority and responsibility for recruiting and hiring workers to provide their self-directed services. These workers are referred to as self-directed workers and are subject to the standards, requirements, policies, and procedures for such workers under the participant’s Home- and Community-based Services (HCBS) Waiver.

Shared Home Supports. An individually tailored supportive service that assists with the acquisition, retention, or improvement in skills related to living in the community. A participant is matched with a shared home supports caregiver. This arrangement is overseen by a residential support agency. Shared home supports do not include 24-hour care. Shared home supports include such supports as adaptive skill development; assistance with ADLs and IADLs; adult educational supports; social and leisure skill development; and supervision.

Shared Living - 24-hour Supports. A residential option that matches a participant with a shared living caregiver. This arrangement is overseen by a residential support agency. Shared living is an individually tailored 24 hours per day/seven days per week, supportive service available to a participant who needs daily structure and supervision. Shared living includes supportive services that assist with the acquisition, retention, or improvement of skills related to living in the community. This includes such supports as: adaptive skill development, assistance with ADLs and IADLs, adult educational supports, social and leisure skill development, protective oversight, and supervision.

Skilled Nursing Services. The assessment, planning, provision, and evaluation of goal-oriented nursing care that requires specialized knowledge and skills acquired under the established curriculum of a school of nursing approved by a board of registration in nursing. Such services include only those services that require the skills of a nurse. Skilled nursing services are provided by a person licensed as a registered nurse or a licensed practical nurse by a state’s board of registration in nursing.

Specialized Medical Equipment and Supplies. Devices, controls, or appliances to increase abilities in activities of daily living, or to control or communicate with the environment.

Final Adoption Date Published in Mass. Register: November 07, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 359.00: RATES FOR HOME- AND COMMUNITY-BASED SERVICES WAIVERS

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Speech Therapy. Therapy services, including diagnostic evaluation and therapeutic intervention, that are designed to improve, develop, correct, rehabilitate, or prevent the worsening of speech/language communication and swallowing disorders that have been lost, impaired, or reduced as a result of acute or chronic medical conditions, congenital anomalies, or injuries. Speech and language disorders are those that affect articulation of speech, sounds, fluency, voice, swallowing (regardless of presence of a communication disability), and those that impair comprehension, spoken, written, or other symbol systems used for communication.

Supported Employment. Regularly scheduled services that enable participants, through training and support, to work in integrated work settings in which individuals are working toward compensated work, consistent with the strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice of the individuals.

Supportive Home Care Aide. Services provided to participants with Alzheimer’s/dementia or behavioral health needs to assist with ADLs and IADLs. These services include personal care, shopping, menu planning, meal preparation including special diets, laundry, light housekeeping, escort, and socialization/emotional support.

Transitional Assistance. Nonrecurring residential set-up expenses for participants who are transitioning from a nursing facility or hospital to a community living arrangement where the participant is directly responsible for his or her own set-up expenses. Allowable expenses are those that are necessary to enable a person to establish a basic household and do not constitute room and board.

Transportation Services. Conveyance of participants by vehicle from their residence to and from the site of HCBS waiver services and other community services, activities, and resources, including physical assistance to participants while entering and exiting the vehicle.

Vehicle Modification. Necessary adaptations or alterations to an automobile or van that is the waiver participant’s primary means of transportation and that is not owned or leased by an entity providing services to the participant. Vehicle modifications are necessary when they are required to accommodate the special needs of the participant. Examples of vehicle modifications include: van lift, tie downs, ramp, specialized seating equipment, and seating/safety restraint.

Waiver Services. Home- and community-based services that are covered in accordance with the requirements of 130 CMR 630.000: Home- and Community-based Services Waiver Services for participants enrolled under an ABI or MFP waiver.

359.03 Rate Provisions

359.03: Rate Provisions

(1) Services Included in the Rate. The approved rate will include payment for all care and services that are part of the program of services of a provider, as explicitly set forth in the terms of the purchase agreement between the provider and the purchasing governmental unit(s).

Final Adoption Date Published in Mass. Register: November 07, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

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(2) Reimbursement as Full Payment. Each 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 for services included in the scope of 101 CMR 359.00 from any other source must be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the participant.

(3) Payment Limitations. (a) No purchasing governmental unit may pay less than or more than the approved program rate, except that a participant contribution may be applied toward the residential habilitation room and board payment in accordance with policies and procedures established by the purchasing governmental unit. (b) Where more than one payment rate is available for a covered service, the service is covered at the lowest available payment rate unless a higher rate is approved by the purchasing governmental unit, except as provided in 101 CMR 359.03(3)(c). (c) Notwithstanding the requirement of 101 CMR 359.03(3)(b), payment rates for certain HCBS waiver services will be determined as follows.

  1. Residential Habilitation Rates. Residential habilitation rates will be determined in the following manner: a. Service Model Rate. The purchasing governmental unit will designate the applicable rate from among the basic lower intensity, basic, or intermediate categories, or at medical/clinical level 1, medical/clinical level 2, or medical/clinical level 3, as outlined and defined in 101 CMR 420.00: Rates for Adult Long-term Residential Services. b. Room and Board. The purchasing governmental unit will designate the applicable rate for room and board from among the site rates outlined in 101 CMR 420.00: Rates for Adult Long-term Residential Services.
  2. Orientation and Mobility. Orientation and mobility rates will be determined based on one-way distance traveled to initiate the service in the following manner:
    1. Level I: one to 30 miles;
    2. Level II: 31 to 60 miles; and
    3. Level III: over 60 miles.
  3. Shared Home Supports. The purchasing governmental unit will designate the applicable stipend rate at level 1, 2, or 3, as outlined and defined in 101 CMR 411.00: Rates for Certain Placement, Support, and Shared Living Services.
  4. Shared Living - 24 Hour Supports. Shared living – 24-hour support rates will be determined in the following manner. a. Operational Rate. The purchasing governmental unit will designate the applicable rate from among the available operational rate levels as outlined and defined in 101 CMR 411.00: Rates for Certain Placement, Support, and Shared Living Services. b. Stipend Rate. The purchasing governmental unit will designate the applicable rate from among the available stipend levels, corresponding to the designated operational rate level as outlined and defined in 101 CMR 411.00: Rates for Certain Placement, Support, and Shared Living Services.

(4) Approved Rates.

Final Adoption Date Published in Mass. Register: November 07, 2025

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The approved rate will be the lowest of the provider’s charge or amount accepted as payment from another payer or the rate listed in 101 CMR 359.03(4). Service HCBS Waiver Units Agency Rate Non-agency Rate Individual Provider (Self- employed Provider ) Self-directed Service Adult Companion ABI-N, MFP-CL Per 15 Min. $8.04 80.00% of Agency Rate 80.00% of Agency Rate Assisted Living ABI-RH, MFP-RS Per Diem $114.80 N/A N/A Assistive Technology - devices ABI-N, ABI-RH, MFP-CL, MFP-RS Per Device IC N/A N/A Assistive Technology - evaluation and training ABI-N, ABI-RH, MFP-CL, MFP-RS Per 15 Min. See 101 CMR 423.00: Rates for Certain In-Home Basic Living Supports 89.75% of Agency Rate N/A Chore ABI-N, MFP-CL Per 15 Min. $11.69 80.00% of Agency Rate

80.00% of Agency Rate

Community-based Day Supports ABI-N, ABI-RH, MFP-CL, MFP-RS Per 15 Min. See 101 CMR 415.00: Rates for Community- based Day Support Services; Levels A, B, C, & I N/A N/A Community Support and Navigation ABI-N, ABI-RH, MFP-CL, MFP-RS Per 15 Min. See 101 CMR 444.00: Rates for Certain Substance Use Disorder Services: Recovery Support Navigator Service N/A N/A

Final Adoption Date Published in Mass. Register: November 07, 2025

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Service HCBS Waiver Units Agency Rate Non-agency Rate Individual Provider (Self- employed Provider ) Self-directed Service Community Family Training ABI-N, MFP-CL Per 15 Min. See 101 CMR 414.00: Rates for Family Stabilization Services (Family Training rate divided by 4 to determine rate per 15-minute increments) 89.75% of Agency Rate N/A Day Services ABI-N, ABI-RH, MFP-CL, MFP-RS Per Diem See 101 CMR 348.00: Rates for Day Habilitation Services: Skills Training and Development Per Diem, Level 2 N/A N/A Day Services – half per diem ABI-N, ABI-RH, MFP-CL, MFP-RS Half Per Diem See 101 CMR 348.00: Rates for Day Habilitation Services: Skills Training and Development Half Per Diem, Level 2 N/A N/A Home Accessibility Adaptations ABI-N, ABI-RH MFP-CL, MFP-RS Item IC IC N/A Home Delivered Meals ABI-N, MFP-CL Meal $10.25 N/A N/A Home Health Aide ABI-N, MFP-CL Per 15 Min. See 101 CMR 350.00: Rates for Home Health Services N/A N/A Homemaker ABI-N, MFP-CL Per 15 Min. $9.63 80.00% of Agency Rate 80.00% of Agency Rate

Final Adoption Date Published in Mass. Register: November 07, 2025

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Service HCBS Waiver Units Agency Rate Non-agency Rate Individual Provider (Self- employed Provider ) Self-directed Service Independent Living Supports ABI-N, MFP-CL Per Diem $90.20 N/A N/A Individual Support and Community Habilitation ABI-N, ABI-RH, MFP-CL, MFP-RS Per 15 Min. See 101 CMR 423.00: Rates for Certain In-home Basic Living Supports; Levels G-H & I 89.69% of Agency Rate 89.69% of Agency Rate Laundry ABI-N, MFP-CL Per Order $30.67 N/A N/A Occupational Therapy ABI-N, ABI-RH, MFP-CL, MFP-RS Per Visit See 101 CMR 350.00: Rates for Home Health Services See 101 CMR 339.00: Restorative Services (out- of-office visit rate) N/A Orientation and Mobility Services MFP-CL, MFP-RS Per 15 Min Level I: $33.58 Level II: $37.12 Level III: $40.66 Level I: $33.58 Level II: $37.12 Level III: $40.66 N/A Peer Support ABI-N, ABI-RH, MFP-CL, MFP-RS Per 15 Min. See 101 CMR 414.00: Rates for Family Stabilization Services (rate divided by 4 to determine rate per 15-minute increments) 89.75% of Agency Rate 89.75% of Agency Rate Personal Care ABI-N, MFP-CL Per 15 Min. $9.73 See 101 CMR 309.00: Rates for Certain Services for the Personal Care See 101 CMR 309.00: Rates for Certain Services for the Personal Care Attendant Program

Final Adoption Date Published in Mass. Register: November 07, 2025

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Service HCBS Waiver Units Agency Rate Non-agency Rate Individual Provider (Self- employed Provider ) Self-directed Service Attendant Program Physical Therapy ABI-N, ABI-RH, MFP-CL, MFP-RS Per Visit See 101 CMR 350.00: Rates for Home Health Services See 101 CMR 339.00: Restorative Services (out- of-office visit rate) N/A Prevocational Services ABI-N, ABI-RH, MFP-CL, MFP- RS Per 15 Min. See 101 CMR 419.00: Rates for Supported Employment Services (rate for Individual Supported Employment) N/A N/A Residential Family Training ABI-RH, MFP-RS Per 15 Min. See 101 CMR 414.00: Rates for Family Stabilization Services (Family Training rate divided by 4 to determine rate per 15-minute increments) 89.75% of Agency Rate N/A Residential Habilitation Room and Board ABI-RH, MFP-RS Per Diem See 101 CMR 420.00: Rates for Adult Long-term Residential Services (Site Rates)

N/A

N/A Residential Habilitation Services ABI-RH, MFP-RS Per Diem See 101 CMR 420.00: Rates for Adult Long-term Residential Services (Basic Lower Intensity,

Final Adoption Date Published in Mass. Register: November 07, 2025

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Service HCBS Waiver Units Agency Rate Non-agency Rate Individual Provider (Self- employed Provider ) Self-directed Service Basic, or Intermediate categories, Medical/Clinical Level 1, Medical/Clinical Level 2, or Medical/Clinical Level 3 N/A N/A Respite ABI-N, MFP-CL Per Diem IC N/A N/A Shared Home Supports ABI-N, MFP-CL Per Diem See 101 CMR 411.00: Rates for Certain Placement, Support, and Shared Living Services (Operational Rate Level A, Stipend Levels 1, 2, or 3) N/A N/A Shared Living – 24 Hour Supports ABI-RH, MFP-RS Per Diem See 101 CMR 411.00: Rates for Certain Placement, Support, and Shared Living Services N/A N/A Skilled Nursing – LPN ABI-N, ABI-RH, MFP-CL, MFP-RS Per Visit See 101 CMR 350.00: Rates for Home Health Services (Rates for Skilled Nursing Services) N/A N/A Skilled Nursing – RN ABI-N, ABI-RH, Per Visit See 101 CMR 350.00: Rates for N/A N/A

Final Adoption Date Published in Mass. Register: November 07, 2025

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Service HCBS Waiver Units Agency Rate Non-agency Rate Individual Provider (Self- employed Provider ) Self-directed Service MFP-CL, MFP-RS Home Health Services (Rates for Skilled Nursing Services) Specialized Medical Equipment ABI-N, ABI-RH, MFP-CL, MFP-RS Item See 101 CMR 322.00: Rates for Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment See 101 CMR 322.00: Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment N/A Speech Therapy ABI-N, ABI-RH, MFP-CL, MFP-RS Per Visit See 101 CMR 350.00: Rates for Home Health Services See 101 CMR 339.00: Restorative Services (out- of-office visit rate) N/A Supported Employment ABI-N, ABI-RH, MFP-CL, MFP-RS Per 15 Min. See 101 CMR 419.00: Rates for Supported Employment Services (rate for Individual Supported Employmen t) N/A N/A Supportive Home Care Aide ABI-N, MFP-CL Per 15 Min. See 101 CMR 350.00: Rates for Home Health Services (13.12% above the rate for Home Health Aide) N/A N/A Transitional Assistance ABI-N, ABI-RH, MFP-CL, MFP-RS Per Episode IC N/A N/A

Final Adoption Date Published in Mass. Register: November 07, 2025

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(5) Self-directed Service Rates. (a) Employer Expense Component. The rates for self-directed services consist of two components: the self-directed worker rate and the employer expense component (EEC). The list in 101 CMR 359.03(5)(a) identifies the self-directed worker rates and EEC for self- directed service rates.

Service Unit Self-directed Worker Rate Employer Expense Component Self-directed Service Rate Adult Companion Per 15 Min. $5.82 $0.61 $6.43 Chore Per 15 Min. $8.46 $0.89

$9.35

Homemaker Per 15 Min. $6.97 $0.73 $7.70 Individual Supports and Community Habilitation: Level G Per 15 Min. $12.72 $1.34 $14.06 Individual Supports and Community Habilitation: Level H Per 15 Min. $13.67 $1.44 $15.11 Service HCBS Waiver Units Agency Rate Non-agency Rate Individual Provider (Self- employed Provider ) Self-directed Service Transportation ABI-N, ABI-RH, MFP-CL, MFP-RS One-way Trip See 101 CMR 327.00: Rates of Payment for Ambulance and Wheelchair Van Services N/A N/A Vehicle Modification ABI-N, MFP-CL Item IC N/A N/A

Final Adoption Date Published in Mass. Register: November 07, 2025

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Service Unit Self-directed Worker Rate Employer Expense Component Self-directed Service Rate Individual Supports and Community Habilitation: Level I Per 15 Min. $16.98 $1.78 $18.76 Peer Support Per 15 Min. $7.92 $0.83 $8.75 Personal Care Per 15 Min. See 101 CMR 309.00: Rates for Certain Services for the Personal Care Attendant Program (rate divided by four to determine rate per 15-minute increments)

(b) Overtime Calculation. Overtime payments for self-directed services will be made in accordance with the federal Fair Labor Standards Act. Such payments will be made to self- directed workers at rate of one and a half times that of the rate for the service or services provided. For self-directed workers that provide services paid at different rates, such overtime rate will consist of the blended weighted rate based on the number of hours for which each service was provided during a single work week. For the purposes of 101 CMR 359.03(5)(b), the term overtime will mean self-directed services provided to one or more participants in excess of 40 hours per work week, where work week consists of a seven-day period beginning Sunday at 12:00 A.M. and ending the consecutive Saturday at 11:59 P.M.

(6) Approved Modifiers. The approved modifiers for all four HCBS Waiver programs are as follows. (a) Modifier Classification. The classification descriptions for modifiers associated with both the ABI and MFP Waivers are as follows.

Modifier Description TV Holiday Time (for use by FI only) U1 Agency Provider or Level 1 or Level B or Level G U2 Individual/Self-employed Provider or Level 2 or Level C or Level H U3 Level 3 or Level I U4 ABI Nonresidential Habitation (ABI-N) Waiver U5 ABI Residential Habitation (ABI-RH) Waiver U8 MFP Community Living (MFP-CL) Waiver U9 MFP Residential Supports (MFP-RS) Waiver UB Self-directed Service UC Devices UD Paid Time Off (for use by FI only)

Final Adoption Date Published in Mass. Register: November 07, 2025

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(b) Service Codes and Modifiers by Service. The list of approved service codes and modifiers for all four ABI and MFP Waivers are as follows. The Agency and Individual Provider service codes and modifiers are located in the first table, while the Self-directed Service codes and modifiers are located in the second table below.

Service Agency Individual Provider (Self-employed Provider)

Code 1st Position Modifie r 2nd Position Modifier 3 rd

Position Modifier Code 1st Position Modifie r 2nd Position Modifier 3 rd

Position Modifier Adult Companion S5135 U4 -

S5125 U4 - - S5135 U8 -

S5125 U8 - - Assisted Living T2031 U5 -

T2031 U9 -

Assistive Technology - devices T2029 U4 UC

T2029 U5 UC

T2029 U8 UC

T2029 U9 UC

Assistive Technology – evaluation and training 97755 U4 U1 U3 97755 U4 U2 U3 97755 U4 U1

97755 U4 U2

97755 U5 U1 U3 97755 U5 U2 U3 97755 U5 U1

97755 U5 U2

97755 U8 U1 U3 97755 U8 U2 U3 97755 U8 U1

97755 U8 U2

97755 U9 U1 U3 97755 U9 U2 U3 97755 U9 U1

97755 U9 U2

Chore Services S5120 U4 U1

S5120 U4 U2 - S5120 U8 U1

S5120 U8 U2 - Community- based Day Supports S5100 U4 -

S5100 U4 U1

S5100 U4 U2

S5100 U4 U3

S5100 U5 -

S5100 U5 U1

S5100 U5 U2

S5100 U5 U3

S5100 U8 -

S5100 U8 U1

S5100 U8 U2

Final Adoption Date Published in Mass. Register: November 07, 2025

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Service Agency Individual Provider (Self-employed Provider)

Code 1st Position Modifie r 2nd Position Modifier 3 rd

Position Modifier Code 1st Position Modifie r 2nd Position Modifier 3 rd

Position Modifier S5100 U8 U3

S5100 U9 -

S5100 U9 U1

S5100 U9 U2

S5100 U9 U3

Community Behavioral Health Support and Navigation H2015 U4 -

H2015 U5 -

H2015 U8 -

H2015 U9 -

Community Family Training S5110 U4 U1

S5110 U4 U2 - S5110 U8 U1

S5110 U8 U2 - Day Services S5102 U4 -

S5102 U5 -

S5102 U8 -

S5102 U9 -

Day Services – half per diem S5101 U4 -

S5101 U5 -

S5101 U8 -

S5101 U9 -

Home Accessibility Adaptations

S5165 U4 U1

S5165 U4 U2 - S5165 U5 U1

S5165 U5 U2 - S5165 U8 U1

S5165 U8 U2 - S5165 U9 U1

S5165 U9 U2 - Home Delivered Meals S5170 U4 -

S5170 U8 -

Homemaker S5130 U4 U1

S5130 U4 U2 - S5130 U8 U1

S5130 U8 U2 - Home Health Aide G0156 U4 -

G0156 U8 -

Independent Living Supports H0043 U4 -

H0043 U8 -

Final Adoption Date Published in Mass. Register: November 07, 2025

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Service Agency Individual Provider (Self-employed Provider)

Code 1st Position Modifie r 2nd Position Modifier 3 rd

Position Modifier Code 1st Position Modifie r 2nd Position Modifier 3 rd

Position Modifier Individual Support and Community Habilitation

H2014 U4 U1 -

H2014 U4 U2 -

H2014 U4 U3 -

H2014 U5 U1 -

H2014 U5 U2 -

H2014 U5 U3 -

H2014 U8 U1 -

H2014 U8 U2 -

H2014 U8 U3 -

H2014 U9 U1 -

H2014 U9 U2 -

H2014 U9 U3 -

S5108 U4 U1

S5108 U4 U2

S5108 U4 U3

S5108 U5 U1

S5108 U5 U2

S5108 U5 U3

S5108 U8 U1

S5108 U8 U2

S5108 U8 U3

S5108 U9 U1

S5108 U9 U2

S5108 U9 U3

Laundry S5175 U4 -

S5175 U8 -

Occupational Therapy S9129 U4 U1

S9129 U4 U2 - S9129 U5 U1

S9129 U5 U2 - S9129 U8 U1

S9129 U8 U2 - S9129 U9 U1

S9129 U9 U2 - Orientation and Mobility Services H2021 U4 U1

H2021 U4 U1 - H2021 U4 U2

H2021 U4 U2 - H2021 U4 U3

H2021 U4 U3 -

Final Adoption Date Published in Mass. Register: November 07, 2025

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Service Agency Individual Provider (Self-employed Provider)

Code 1st Position Modifie r 2nd Position Modifier 3 rd

Position Modifier Code 1st Position Modifie r 2nd Position Modifier 3 rd

Position Modifier H2021 U5 U1

H2021 U5 U1 - H2021 U5 U2

H2021 U5 U2 - H2021 U5 U3

H2021 U5 U3 - H2021 U8 U1

H2021 U8 U1 - H2021 U8 U2

H2021 U8 U2 - H2021 U8 U3

H2021 U8 U3 - H2021 U9 U1

H2021 U9 U1 - H2021 U9 U2

H2021 U9 U2 - H2021 U9 U3

H2021 U9 U3 - Peer Support H0038 U4 U1

H0038 U4 U2 - H0038 U5 U1

H0038 U5 U2 - H0038 U8 U1

H0038 U8 U2 - H0038 U9 U1

H0038 U9 U2 - Personal Care T1019 U4 U1

T1019 U4 U2 - T1019 U8 U1

T1019 U8 U2 - Physical Therapy S9131 U4 U1

S9131 U4 U2 - S9131 U5 U1

S9131 U5 U2 - S9131 U8 U1

S9131 U8 U2 - S9131 U9 U1

S9131 U9 U2 - Prevocational Services T2019 U4 -

T2019 U5 -

T2019 U8 -

T2019 U9 -

Residential Family Training S5110 U5 U1

S5110 U5 U2 - S5110 U9 U1

S5110 U9 U2 - Residential Habilitation T2016 U5 -

T2016 U9 -

Respite H0045 U4 -

H0045 U8 -

Shared Home Supports H2016 U4 U1

H2016 U4 U2

H2016 U4 U3

Final Adoption Date Published in Mass. Register: November 07, 2025

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Service Agency Individual Provider (Self-employed Provider)

Code 1st Position Modifie r 2nd Position Modifier 3 rd

Position Modifier Code 1st Position Modifie r 2nd Position Modifier 3 rd

Position Modifier H2016 U8 U1

H2016 U8 U2

H2016 U8 U3

Shared Living-24- Hour Supports T2033 U5 -

T2033 U9 -

Skilled Nursing - RN G0299 U4 -

G0299 U5 -

G0299 U8 -

G0299 U9 -

Skilled Nursing - LPN G0300 U4 -

G0300 U5 -

G0300 U8 -

G0300 U9 -

Specialized Medical Equipment T2029 U4 -

T2029 U4 U2 - T2029 U5 -

T2029 U5 U2 - T2029 U8 -

T2029 U8 U2 - T2029 U9 -

T2029 U9 U2 - Speech Therapy S9128 U4 U1

S9128 U4 U2 - S9128 U5 U1

S9128 U5 U2 - S9128 U8 U1

S9128 U8 U2 - S9128 U9 U1

S9128 U9 U2 - Supported Employment H2023 U4 -

H2023 U5 -

H2023 U8 -

H2023 U9 -

Supportive Home Care Aide T1004 U4 -

T1004 U8 -

Transportation T2003 U4 -

T2003 U5 -

T2003 U8 -

T2003 U9 -

T2038 U4 -

Final Adoption Date Published in Mass. Register: November 07, 2025

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Service Agency Individual Provider (Self-employed Provider)

Code 1st Position Modifie r 2nd Position Modifier 3 rd

Position Modifier Code 1st Position Modifie r 2nd Position Modifier 3 rd

Position Modifier Transitional Assistance T2038 U5 -

T2038 U8 -

T2038 U9 -

Vehicle Modification T2039 U4 -

T2039 U8 -

Service Self-directed Service

Code 1st Position Modifie r 2nd Position Modifier 3 rd

Position Modifie r 4 th

Position Modifie r Adult Companion S5125 U4 UB

S5125 U8 UB

S5125 U4 UB UD

S5125 U8 UB UD

Chore Services S5120 U4 UB

S5120 U8 UB

S5120 U4 UB UD

S5120 U8 UB UD

Homemaker S5130 U4 UB - - S5130 U8 UB - - S5130 U4 UB UD

S5130 U8 UB UD

Individual Support and Community Habilitation

H2014 U4 U1 UB - H2014 U4 U2 UB - H2014 U4 U3 UB - H2014 U5 U1 UB - H2014 U5 U2 UB - H2014 U5 U3 UB - H2014 U8 U1 UB - H2014 U8 U2 UB - H2014 U8 U3 UB - H2014 U9 U1 UB

Final Adoption Date Published in Mass. Register: November 07, 2025

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Service Self-directed Service

Code 1st Position Modifie r 2nd Position Modifier 3 rd

Position Modifie r 4 th

Position Modifie r H2014 U9 U2 UB

H2014 U9 U3 UB

H2014 U4 U1 UB UD H2014 U4 U2 UB UD H2014 U4 U3 UB UD H2014 U5 U1 UB UD H2014 U5 U2 UB UD H2014 U5 U3 UB UD H2014 U8 U1 UB UD H2014 U8 U2 UB UD H2014 U8 U3 UB UD H2014 U9 U1 UB UD H2014 U9 U2 UB UD H2014 U9 U3 UB UD Peer Support H0038 U4 UB - - H0038 U5 UB - - H0038 U8 UB - - H0038 U9 UB - - H0038 U4 UB UD

H0038 U5 UB UD

H0038 U8 UB UD

H0038 U9 UB UD

Personal Care T1019 U4 UB - - T1019 U8 UB - - T1019 U4 UB UD

T1019 U8 UB UD

T1019 U4 UB TV

T1019 U8 UB TV

359.04 Filing and Reporting Requirements

359.04: Filing and Reporting Requirements

(1) General Provisions. Providers must satisfy the applicable reporting requirements of 957 CMR 6.00: Cost Reporting Requirements, and 808 CMR 1.00: Compliance, Reporting and Auditing for Human and Social Services.

Final Adoption Date Published in Mass. Register: November 07, 2025

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(2) Penalty for Noncompliance. The purchasing governmental unit may impose a penalty of up to 15% for 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 101 CMR 359.04(2).

359.05 Severability

359.05: Severability The provisions of 101 CMR 359.00 are severable. If any provision of 101 CMR 359.00 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 101 CMR 359.00 or application of those provisions to applicable individuals, entities, or circumstances.

REGULATORY AUTHORITY

101 CMR 359.00: M.G.L. c. 118E.

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