Approved State Directed Payment Preprints

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 period covering July 1, 2024 through June 30, 2027, incorporated in the capitation rates through a separate payment term amount up to $36,600,000.

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, 2025 through June 30, 2026, incorporated in the capitation rates through a risk-based rate adjustment up to $2,946,193.

Maximum Fee Schedule for MassHealth contracted acute hospitals (except for specialty cancer hospitals and freestanding pediatric hospitals for an inpatient discharge with a MassHealth DRG Weight of 3 or greater) for the rating period covering January 1, 2026, through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment.

Minimum Fee Schedule and Maximum Fee Schedule for inpatient hospital discharges from freestanding pediatric hospitals, using an approved State plan fee schedule for the rating period covering January 1, 2026 – December 31, 2026.

Uniform dollar increase for pediatric home health nurses established by the state for home health services for the rating period, July 1, 2025 through June 30, 2026,incorporated into the capitation rates through a separate payment term up to $3,307,280.

 Uniform increase for inpatient and outpatient hospital services at freestanding children’s hospitals with more than 100 licensed pediatric beds for the rating period covering October 1, 2025 through September 30, 2026, and incorporated in the capitation rates through a separate payment term of up to $104,870,000.

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.

Uniform dollar increase for pediatric home health nurses established by the state for home health services for the rating period, July 1, 2025 through June 30, 2026,incorporated into the capitation rates through a separate payment term up to $3,307,280.

Maximum Fee Schedule for MassHealth contracted acute hospitals (except for specialty cancer hospitals and freestanding pediatric hospitals for an inpatient discharge with a MassHealth DRG Weight of 3 or greater) for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.