Approved State Directed Payment Preprints

Renewal of the uniform percentage increase established by the state for inpatient and outpatient services by not-for-profit hospitals for the rating period covering January 1, 2024 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.

Renewal of the uniform increase arrangement for trauma hospitals established by the state for inpatient and outpatient services for the rating period covering January 1, 2024through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.

Renewal of the uniform percentage increase established by the state for inpatient and outpatient services provided by practice plans under contract to community hospitals that serve a disproportionate share of Native American enrollees for the rating period covering January 1, 2024 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.

Renewal of the value-based payment and uniform increase established by the state for participating nursing facilities that demonstrate quality improvement for the rating period covering January 1, 2024 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.

Renewal of uniform increase established by the state for inpatient and outpatient hospital services provided by qualifying Public Academic Health Centers 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 $809,000,000.

Renewal of uniform increase established by the state for inpatient and outpatient hospital services provided by Diagnosis-Related Group (DRG) 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 $703,000,000.

Renewal of uniform increase established by the state for inpatient and outpatient hospital services provided by Rural Type A/B 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 $146,000,000.

The value-based payment Patient Centered Medical Home (PCMH)-Kids initiative established by the state for eligible pediatric providers for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.

Uniform increase established by the state for eligible inpatient and outpatient hospital services for the rating period covering January 1, 2023 through March 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.

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, 2022 through December 31, 2022, incorporated in the capitation rates through a risk- based rate adjustment.