Approved State Directed Payment Preprints

Minimum fee schedule for psychiatric services for enrollees under the age of 21 with Autism Spectrum Disorder or Intellectual or Developmental Disability (ASD/IDD) for the rating period covering January 1, 2023 through September 30, 2023, provided by the state’s Prepaid Inpatient Health Plan (PIHP), incorporated in the capitation rates through a risk-based rate adjustment.

Uniform increase established by the state for eligible inpatient and outpatient hospital services for the rating period covering January 1, 2024 through December 31, 2024,incorporated into the capitation rates through a separate payment term of up to$411,000,000.

Uniform increase established by the state for eligible inpatient hospital services for the rating period covering January 1, 2023 through December 31, 2023, incorporated into the capitation rates for the Managed Behavioral Health Vendor through a separate payment term of up to $4,601,248.

Continuous Quality Improvement (CQI) value-based payment arrangement established by the state for private acute hospitals for the rating period covering April 1, 2023 through December 31, 2024, incorporated into the capitation rates through a separate payment term of up to $104,200,00 for April 1, 2023 to December 31, 2023 and up to $147,000,000 for January 1, 2024 to December 31, 2024.

Uniform increase established by the State for Behavioral Health Urgent Care (BHUC) for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a risk-based rate adjustment.

Minimum Fee Schedule established by the State for the Program of Assertive Community Treatment (PACT) for the rating period covering January 1, 2023 through December 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.

Continuous Quality Improvement (CQI) value-based payment arrangement established by the state for inpatient and outpatient behavioral health services provided in private acute hospitals for the rating periods covering January 1, 2023 through December 31, 2024, incorporated into the capitation rates through a separate payment term of up to $4,393,000 in the Massachusetts Behavioral Health Partnership program.

Minimum Fee Schedule and Maximum Fee Schedule for inpatient hospital discharges from freestanding pediatric hospitals with a MassHealth DRG weight of 3.0 or greater and hospitals with a pediatric specialty unit with a MassHealth DRG weight of 3.0 or greater, using an approved State plan fee schedule for the rating period covering January 1, 2024 – December 31, 2024.

Primary Care Sub capitated Arrangement established by the state for the rating period, January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a risk-based adjustment.

Primary Care Sub capitated Arrangement established by the state for the rating period, April 1, 2023 through December 31, 2023, incorporated into the capitation rates through a risk-based adjustment.