Approved State Directed Payment Preprints

The value based payment arrangement for non-state, public hospitals that contract with the Commonwealth’s Prepaid Inpatient Health Plan (PIHP) to enhance the quality of behavioral health services provided on an outpatient and inpatient basis to MassHealth members for the rating period covering January 1, 2023 to December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $60 million for the January 1, 2023 – December 31, 2023; $60 million for the January 1, 2024 – December 31, 2024; and $60 million for the January 1, 2025 – December 31, 2025.

The Hospital Quality Incentive proposal for the rating period covering January 1, 2023 through March 31, 2023, incorporated in the capitation rates through a separate payment term of up to $40.2 million.

Integrated Care Incentive proposal for non-state, public hospitals for the rating period covering January 1, 2023 to March 31, 2023, incorporated in the capitation rates through a separate payment term of up to $37.2 million.

Uniform percentage increase established by the state for the professional services at an academic medical center for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $39,420,290.00; Performance improvement initiative established by the state for the professional services at an academic medical center for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $39,420,290.00.

Minimum fee schedule established by the state for public ambulance provider services for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.

Uniform dollar increase established by the state for local health department services for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $55,500,000.

Uniform dollar increase established by the state for behavioral health inpatient services for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.

Uniform increase established by the state for specific behavioral health outpatient services for the rating period covering January 1, 2023, through December 31, 2023, incorporated in the capitation rates through a separate payment term of up to $30 million.

Uniform increase for inpatient hospital services provided by Class II (publicly owned) nursing facilities with greater than 500 licensed beds for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $14,747,200.

The uniform dollar increase for inpatient hospital services provided by Atlantic County hospitals for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $68,929,587.