Approved State Directed Payment Preprints

Renewal of a value-based purchasing and uniform percent increase arrangement established by the state to increase nursing facility per diem rates by the market basket index (MBI) factor and to provide quality incentive payments for nursing facilities that meet performance requirements on specified quality metrics for the rating period covering July 1, 2025 through December 31, 2025, incorporated into the capitation rates through a risk-based adjustment.

Uniform percentage increase established by the state for nursing facility services for the rating period, January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term of up to $80,545,210.00.

Uniform increase for non-state owned or operated hospitals established by the state for inpatient and outpatient hospital services for the rating period, January 1, through December 31, 2024, incorporated into the capitation rates through a separate payment term of up to $705,533,735.

Uniform percentage increase and value-based payment established by the state for professional services at an academic medical center, primary care services, specialty physician services, and qualifying practitioner services for the rating period covering January 1, 2025 through December 31, 2025 incorporated in the capitation rates through a separate payment term amount up to $42 million.

Maximum Fee Schedule for MassHealth contracted acute hospitals (except for specialty cancer hospitals and freestanding pediatric hospitals for an inpatient discharge with a MassHealth DRG Weight of 3 or greater) for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.

Uniform dollar increase for government-owned or operated ground ambulance providers for the rating period covering July 1, 2025, through June 30, 2026, incorporated in the capitation rates through a separate payment term amount of up to $82,280,786.

Maximum fee schedule for inpatient and outpatient hospital services established by the state for the rating period covering July 1, 2024, through June 30, 2025, incorporated in the capitation rates through a risk-based rate adjustment.

Fee schedule and value-based payment arrangement for behavioral health and home and community-based services providers for the rating period covering January 1, 2024through December 31, 2024.

Population-based payment for primacy care services for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.

Minimum Fee Schedule for primary care services for the rating period covering January1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.