Approved State Directed Payment Preprints

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, and the acute hospital with a pediatric specialty unit for enrollees under the age of 21 at the time of admission for an inpatient discharge with a MassHealth DRG Weight of 3 or greater) for the rating period covering January 1, 2023 through March 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.

Uniform dollar increase established by the state for dental services for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a risk-based adjustment.

Uniform dollar increase established by the state for inpatient and outpatient hospital services at District 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 $207,290,924.

Minimum and maximum fee schedule for Sub-Acute Psychiatric Community-Based Psychiatric and Recovery Center Services for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a risk-based adjustment.

Uniform dollar increase established by the state for developmental screening services for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a risk-based rate adjustment.

Uniform dollar increase established by the state for Family Planning services for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a risk-based rate adjustment.

Quality Incentive Pool for District and Municipal Public Hospital Systems for the rating periods covering January 1, 2021 through December 31, 2023, incorporated in the CY 2023 capitation rates through a separate payment term of up to $192,062,936.53.

Quality Incentive Pool for Designated Public Hospital systems for the rating periods covering January 1, 2021 through December 31, 2023, incorporated in the CY 2023 capitation rates through a separate payment term of up to $2,040,316,388.17.

Continuous Quality Improvement (CQI) value-based payment arrangement established by the state for private acute hospitals for the rating period covering January 1, 2023 through March 31, 2023, incorporated into the capitation rates through a separate payment term of up to $37,876,200.

Minimum fee schedule established by the state for eligible inpatient and outpatient hospital services, professional services at an academic medical center, ambulance services, and anesthesia services for the rating period, January 1, 2023 through December 31, 2023, incorporated into the capitation rates through a risk-based rate adjustment.