Approved State Directed Payment Preprints

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, 2025 – December 31, 2025.

A value-based payment arrangement for hospitals providing labor and delivery services for the rating period covering April 1, 2025 through March 31, 2026, incorporated in the capitation rates through a separate payment term of up to $50 million.

Rural Access to Primary and Preventative Services (RAPPS), which is a uniform increase for Rural Health Clinics, for the rating period covering September 1, 2025through August 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment.

Value based payment arrangement established by the state for eligible primary care providers with the Lurie Children's Hospital All Hands Health Network (AHHN) for the rating periods covering January 1, 2025 through December 31, 2026 incorporated in the capitation rates through a risk-based rate adjustment.

The value-based payment for eligible community mental health centers established by the state for behavioral health outpatient services for the rating period covering July 1,2025 through June 30, 2026, incorporated into the capitation rates through a risk-based rate adjustment.

Uniform increase for non-emergency medical transport providers for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term of up to $2,800,584.

Uniform percentage increase for services performed by physicians employed by or contracted with NSGO hospitals for the rating period covering July 1, 2025 through June30,2026, incorporated in the capitation rates through a separate payment term amount of up to $950,000.

Uniform dollar increase for pediatric home health nurses established by the state for home health services for the rating period, July 1, 2025 through June 30, 2026,incorporated into the capitation rates through a separate payment term up to $3,307,280.

Minimum Fee Schedule established by the state for public ambulance provider services for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a risk-based rate adjustment.

Minimum fee schedules established by the state for the following provider classes and services for the rating period, January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a risk-based rate adjustment:

• Nursing facilities
• HCBS providers for individuals who are elderly and/or have physical disabilities
• HCBS providers for individuals with intellectual and developmental disabilities
• Providers of behavioral health crisis prevention, intervention, and stabilization service for individuals with intellectual disabilities
• Behavioral health mobile crisis centers
• Dental service providers