Approved State Directed Payment Preprints

A uniform dollar increase established by the state for eligible public and government-owned emergency medical transport providers for the rating period covering January 1, 2024 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $7.72 million.

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.

Value based payment for Certified Community Behavioral Health Centers (CCBHCs) for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $1,601,799.59.

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.

The maximum fee schedule for outpatient hospital services established by the state for the rating period, October 1, 2023 through September 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.

Minimum fee schedule for behavioral health services furnished by qualified providers for the rating period covering January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a risk-based rate adjustment.

Uniform increase established by the state for behavioral health services furnished by qualified providers, including Traditional Health Workers, while providing Culturally and Linguistically specific services (CLSS) and certification standards for the rating period covering January 1, 2025 through December 31, 2025.

Uniform increase established by the state for behavioral health services furnished by qualified providers delivering services to members with co-occurring disorders (COD) for the rating period covering January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a risk-based rate adjustment.