Approved State Directed Payment Preprints

Uniform dollar increase for pediatric home health nurses established by the state for home health services for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $3,307,280.

Uniform increase for non-emergency medical transport providers for the rating period covering July 1, 2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term of up to $2,800,584.

The Hospital Quality Incentive proposal for non-federal, non-state owned, public hospitals for inpatient hospital services 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 $93.8 million for April 1, 2023 through December 31, 2023 and $160.8 million for January 1, 2024 through December 31, 2024.

Uniform increase and value-based payment arrangement established by the state to implement the Healthcare Delivery Access Act, for inpatient and outpatient hospital services for the rating period July 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $750 million.

The uniform increase for behavioral health outpatient services and behavioral health diversionary services established by the state for the rating period covering January 1, 2023 through December 31, 2023, provided by the MA Behavioral Health Partnership, Senior Care Options (SCO), or One Care plans, incorporated into the capitation rates through a risk-based adjustment.

The uniform dollar increase established by the state for direct care workers providing personal care services to eligible enrollees for the rating period covering October 1, 2024 through September 30, 2025, incorporated in the capitation rates through a risk-based rate adjustment.

Minimum fee schedule established by the state for eligible specialty physician services that are covered at 100% of Medicare and eligible behavioral health outpatient services that are covered at 80% of Medicare consistent with the requirements of the
Consolidated Appropriations Act of 2023 for the rating period covering October 1, 2023 through September 30, 2024 incorporated in the capitation rates through a risk-based adjustment.
 

Uniform increase established by the State for Behavioral Health Urgent Care (BHUC) for the rating period covering January 1, 2023 through December 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.

Minimum fee schedule established by the State for outpatient behavioral health services and behavioral health diversionary services for the rating period covering January 1, 2023 through December 31, 2023, provided by the MA Behavioral Health Partnership, Senior Care Options (SCO), or One Care plans, and incorporated in the capitation rates through a risk-based rate adjustment.

The minimum fee schedule for Acute Treatment Services (ATS) and Clinical Support Services (CSS) (which may include individualized treatment services in a specialized setting), and Residential Rehabilitation Services (RRS) services established by the state for the rating period covering January 1, 2023 through December 31, 2023, incorporated into the capitation rates through a risk-based adjustment.