101 CMR 432.00 — Rates for Certain Lead Agency Services

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

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 432.00: RATES FOR CERTAIN LEAD AGENCY SERVICES

1 Section

432.01: General Provisions 432.02: Definitions 432.03: Rate Provisions 432.04: Filing and Reporting Requirements 432.05: Severability

101 CMR 432.00 Rates for Certain Lead Agency Services

432.01 General Provisions

432.01: General Provisions

(1) Scope. 101 CMR 432.00 governs the payment rates for certain lead agency services purchased by governmental units, including the Department of Children and Families.

(2) Applicable Dates of Service. Rates contained within 101 CMR 432.00 apply for dates of service provided on or after July 1, 2025.

(3) Disclaimer of Authorization of Services. 101 CMR 432.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 432.00. Governmental units that purchase the services described in 101 CMR 432.00 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 101 CMR 432.00.

432.02 Definitions

432.02: Definitions

As used in 101 CMR 432.00, unless the context requires otherwise, terms have the meanings in 101 CMR 432.02.

Client. An individual that receives certain lead agency 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.

Flex Funding. A method whereby, subject to availability, a purchasing governmental unit may provide resource allocations to a client(s) and/or provider(s) across the state. Flexible funding may be provided through a number of means including, but not limited to, reimbursement to client for specific support services or funds directed to a qualified provider for extraordinary circumstances.

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

Individual Consideration (IC). Payment rates for certain services are designated as individual consideration (IC). Where IC rates are designated, the purchasing governmental unit will

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

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 432.00: RATES FOR CERTAIN LEAD AGENCY SERVICES

2 determine the appropriate payment as the actual cost of the item or service as evidenced by invoice, published tuition amount, or other price reasonably obtained by a competitive market for the product or service.

Lead Agency. An agency that works in partnership with Massachusetts Department of Children and Families Area Offices and its communities to support and enhance the performance of the Area Offices in achieving positive permanent outcomes for children and their families. The lead agency does this by serving as the hub for coordinating purchased services and non-paid community supports.

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 contracted 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).

432.03 Rate Provisions

432.03: 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) Services Provided on the Islands of Martha’s Vineyard and Nantucket. In accordance with the provisions of St. 2016, c. 133, payment for services provided in programs located on the islands of Martha’s Vineyard and Nantucket will be made at the rate for the service contained in 101 CMR 432.03(6) times a factor of 1.07.

(5) 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.

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

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 432.00: RATES FOR CERTAIN LEAD AGENCY SERVICES

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(6) 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 101 CMR 432.03.

Service Tier Unit of Service Rate Lead Agency 1 Month $33,333 2 Month $40,366 3 Month $47,012 4 Month $51,662 5 Month $72,407 6 Month $95,766 Flex Funding n/a IC Case Manager/ Education Coordinator (0.5 FTE) Add-on Month $3,948 Case Manager/ Education Coordinator (1.0 FTE) Add-on Month $7,895

432.04 Filing and Reporting Requirements

432.04: 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 101 CMR 432.04(3).

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

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 432.00: RATES FOR CERTAIN LEAD AGENCY SERVICES

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432.05 Severability

432.05: Severability

The provisions of 101 CMR 432.00 are severable. If any provision of 101 CMR 432.00 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 432.00 or application of those provisions to applicable individuals, entities, or circumstances.

REGULATORY AUTHORITY

101 CMR 432.00: M.G.L. c. 118E.