Approved State Directed Payment Preprints

Population-based payment established by the state for Medicaid managed care enrollees attributed to eligible primary care providers who have active New York State Patient Centered Medical Home (PCMH) recognition for the rating period, April 1, 2024 through March 31, 2025, incorporated into the capitation rates through a separate payment term up to $132,600,000.
 

Uniform dollar increase established by the state for emergency ground ambulance providers 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$62,463,235.

Renewal of the uniform dollar increase for inpatient and outpatient hospital services and performance-based quality payments established by the state for the State Teaching Hospital that provides guaranteed access to care for Native Americans for the rating period covering July 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $155 million.

The Uniform Increase for eligible Acute Care Hospitals established by the state for Inpatient, Outpatient, and Physician Services for the rating period covering July 1, 2023through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $343,997,344.

Uniform dollar increase for community mental health programs for the rating period covering September 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term of up to $4,166,666.67.

Uniform percentage increase for outpatient hospital services, primary care services, specialty physician services, behavioral health outpatient services, dental services, and providers providing EPSDT services, established by the state for the rating period covering July 1, 2023, through June 30, 2024, incorporated in the capitation rates through a rate adjustment of up to $5,700,000.

Maximum Fee Schedule for MassHealth contracted acute hospitals (except for specialty cancer hospitals, freestanding pediatric hospitals for an inpatient discharge with a MassHealth DRG Weight of 3 or greater) for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a risk-based rate adjustment.

The Targeted Investment program for Primary Care Providers established by the state for the rating period covering October 1, 2021 through September 30, 2022 incorporated in the capitation rates through a separate payment term of up to $21.7 million.

The Targeted Investment program established by the state for behavioral health outpatient ambulatory focus areas for the rating period covering October 1, 2021 through September 30, 2022, and incorporated in the capitation rates through a separate payment term of up to $23.8 million.

Uniform increase for eligible inpatient and outpatient services at eligible private hospitals for the rating period January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term up to $892,212,397.