The state has released the 2018 Request for Applications (RFA) – the main contract between the MassHealth program and acute care hospitals serving Medicaid patients.
This year’s RFA is somewhat unusual in that it creates two distinct rate periods – one that runs from October 1, 2017 to February 28, 2018, and then another that follows to Fiscal year’s end that covers the effective dates of the new, sweeping MassHealth Accountable Care Organization (ACO) and Managed Care Organization (MCO) programs. The rate changes that take effect in the second half of the year are intended to coincide with other financial payment policies associated with these new programs.
“This proposed policy effectively moves the state into setting the reimbursement rates paid by MCOs to hospitals, reimbursement that has been customarily negotiated between hospitals and MCOs,” said MHA’s Executive Vice President Tim Gens. “This action puts hospitals at a significant disadvantage with these insurers, eliminating the possibility of a fair negotiation. The ability of hospitals and other providers to negotiate independently with MCOs is critical to ensure the added value a hospital may provide to support care management of MCO enrollees and to be a key network provider for the MCO in a particular service area.”