Approved State Directed Payment Preprints

Uniform percentage increase of 14.7% per claim for nursing facility services for the rating period covering July 1, 2024, through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment in the amount of $14,961,418.

Uniform dollar increase established by the state for nursing facility services for the rating period, October 1, 2025 through September 30, 2026, incorporated into the capitation rates through a separate payment term up to $95,400,000.

Value-based payment arrangement for general and pediatric dentists practicing in dental clinics, Federally Qualified Health Centers, and Rural Health Clinics and who are participating in the Medicaid dental program for the rating periods covering July 1, 2024through June 30, 2027, incorporated into the capitation rates through a separate payment term up to $36,600,000.

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, 2025 – December 31, 2025.

A value-based payment arrangement for hospitals providing labor and delivery services for the rating period covering April 1, 2025 through March 31, 2026, incorporated in the capitation rates through a separate payment term of up to $50 million.

Rural Access to Primary and Preventative Services (RAPPS), which is a uniform increase for Rural Health Clinics, for the rating period covering September 1, 2025through August 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment.

Value based payment arrangement established by the state for eligible primary care providers with the Lurie Children's Hospital All Hands Health Network (AHHN) for the rating periods covering January 1, 2025 through December 31, 2026 incorporated in the capitation rates through a risk-based rate adjustment.

The value-based payment for eligible community mental health centers established by the state for behavioral health outpatient services for the rating period covering July 1,2025 through June 30, 2026, incorporated into the capitation rates through a risk-based rate adjustment.

Uniform increase for non-emergency medical transport providers for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term of up to $2,800,584.

Uniform percentage increase for services performed by physicians employed by or contracted with NSGO hospitals for the rating period covering July 1, 2025 through June30,2026, incorporated in the capitation rates through a separate payment term amount of up to $950,000.