Approved State Directed Payment Preprints

Uniform percentage increase and performance improvement initiative payments established by the state for eligible inpatient and hospital services 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 $1,540,423,694.

The uniform increase for critical access hospitals established by the state for outpatient hospital services for the rating period, January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $13,500,000.

Uniform percentage increase for inpatient and outpatient hospital services provided by eligible general hospitals, for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $41,000,000.

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 until September 30, 2025 incorporated in the capitation rates through a risk-based rate adjustment.

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.