Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 435.000 - Chronic Disease And Rehabilitation Inpatient Hospital Services
Section 435.405 - Rates of Payment
Current through Register 1531, September 27, 2024
(A) Payments to in-state hospitals for services furnished to MassHealth members are equal to the rate established in the signed provider agreement with the MassHealth agency.
(B) Payments to out-of-state hospitals are made in accordance with 130 CMR 450.233. The Medicaid program rate methodology of that state will apply when such methodology is compatible with the MassHealth agency's claims-processing system. Otherwise, the MassHealth agency and the out-of-state facility will negotiate a rate comparable to the median or weighted average in-state rate for similar facilities.
(C) The hospital must accept the amount of payment established by 130 CMR 435.405 as payment in full for all care and services provided by the hospital for which payment is available under MassHealth.
