Approved State Directed Payment Preprints

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.

The Integrated Care Incentive proposal for inpatient and outpatient hospital services at non-federal, non-state-owned, public hospitals for the rating period covering April 1, 2023 through December 31, 2024 through a separate payment term of up to $86.8 million for April 1, 2023 through December 31, 2023 and $148.8 million for January 1, 2024 through December 31, 2024.

The Behavioral Health Quality Incentive proposal for non-federal, non-state-owned, public hospitals for behavioral health inpatient and outpatient services for the rating period covering January 1, 2023 through December 31, 2024 incorporated in the capitation rates through a separate payment term of up to $60 million for January 1, 2023 through December 31, 2023 and $72 million for January 1, 2024 through December 31, 2024.

The minimum fee schedule for behavioral health outpatient services, 24 hour diversionary substance use disorder services and behavioral health diversionary services including the Program for Assertive Community Treatment (PACT), Recovery Coach (RC) and Recovery Support Navigator (RSN) Services, Community Based Acute Treatment (CBAT), Acute Treatment Services (ATS), Clinical Stabilization Services (CSS), and Residential Rehabilitation Services (RRS) for the rating period covering January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a risk-based adjustment.

The alternative minimum fee schedule established by the state for qualifying providers under specific American Society of Addition Medicine (ASAM) levels of care who provided substance use disorder (SUD) treatment for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk based rate adjustment.

The minimum fee schedule for providers involved in the Integrated Community Wellness Center (ICWC) for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.

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.

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.

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.