Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA 02111
TRANSMITTAL LETTER ADH-19
Adult Day Health Providers Participating in MassHealth
Beth Waldman, Medicaid Director
Adult Day Health Manual (Continuation of Transitional Payment Rate)
This letter transmits revisions to the adult day health regulations to continue the transitional
payment rate to certain dementia day service providers. This per diem rate was scheduled to
expire on June 30, 2004, but line item 4000-0600 of Section 2 of Chapter 149 of the Acts of
2004 contained funding to continue this payment. The per diem rate is paid to dementia day
service providers under contract with Aging Service Access Points under the Executive Office of
Elder Affairs Home and Community Based Waiver Program in lieu of the adult day health (ADH)
rates of payment established by the Division of Health Care Finance and Policy (DHCFP) for
providing complex care to a member.
These regulations were filed as an emergency, effective July 1, 2004. The effect of this
amendment is that dementia day services provided after June 30, 2004, will continue to be paid
at the transitional payment rate.
Transitional Payment Rate
The code assigned to this service is outlined in Subchapter 6 of the Adult Day Health Manual.
Providers must bill for ADH services provided at the transitional payment rate by using two units
per attendance day to remain in compliance with 130 CMR 404.415(C), which states, “Members
must attend at least six hours each day, excluding transportation time to and from the program.
Any alteration of this requirement is at the discretion of MassHealth and must be approved.”
All regulatory and payment rate information about the transitional payment rate can be found in
the Adult Day Health Manual at 130 CMR 404.414(D).
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