EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
COMMONWEALTH OF MASSACHUSETTS
OFFICE OF MEDICAID
ONE ASHBURTON PLACE, BOSTON, MA 02108
MAURA T. HEALEY KATHLEEN E. WALSH
GOVERNOR SECRETARY
KIMBERLEY DRISCOLL MIKE LEVINE
LIEUTENANT GOVERNOR ASSISTANT SECRETARY
FOR MASSHEALTH
June 20, 2024
Chair Michael J. Rodrigues Chair Aaron Michlewitz
Senate Committee on Ways and Means House Committee on Ways and Means
State House, Room 212 State House, Room 243
Boston, MA 02133 Boston, MA 02133
Chair John C. Velis Chair Adrian C. Madaro
Joint Committee on Mental Health, Joint Committee on Mental Health,
Substance Use and Recovery Substance Use and Recovery
State House, Room 519 State House, Room 33
Boston, MA 02133 Boston, MA 02133
Dear Chairs Rodrigues, Michlewitz, Velis, and Madaro,
Budget line item 4000-0500 of Section 2 of Chapter 28 of the Acts of 2023 requires the Executive Office
of Health and Human Services to conduct and submit a comparative analysis of the rate differential for
inpatient psychiatric hospitals and substance abuse treatment hospital per diem payments. The
comparative analysis should analyze the per diem payments made by MassHealth Managed Care Entities
(MCEs), including Managed Care Organizations, Accountable Care Partnership Plans, the behavioral
health vendor, One Care, and Senior Care Options (SCO) plans, in comparison to the MassHealth (MH)
Fee for Service (FFS) rate.
Table 1: Psychiatric Inpatient Hospital/Unit Rates (Per Diem) reported as of December 2023.
MH FFS All Other Payors
Age Group Type Minimum Maximum Average Median
Adult IP $954.59 $710.00 $2,064.36 $1,057.36 $955.00
Child IP $954.59 $804.83 $2,409.09 $1,131.11 $975.00
All IP $954.59 $710.00 $2,409.09 $1,073.89 $960.00
Table 1 depicts the psychiatric inpatient per diem rates by age group for MassHealth FFS in comparison
to the MCE rates. Please note that effective July 1, 2021, MassHealth contracted MCEs are required to
adopt the MassHealth FFS psychiatric hospital/unit per diem rate as a rate floor. This requirement does
not apply to Senior Care Organizations or One Care plans. The current MassHealth FFS psychiatric
hospital/unit per diem rate is $954.59. The MassHealth FFS psychiatric inpatient per diem rate is paid in
addition to the per inpatient admission rate, resulting in a higher effective per diem.
As noted in the above table, the MCE per diem rate for adult psychiatric units ranges from a minimum of
$710.00 to a maximum of $2,064.36 with an average rate of $1,057.36 and a median of $955.00. The
child minimum rate for psychiatric inpatient units is $954.49 and the maximum rate is $2,409.09. The
average rate for psychiatric child units among MCEs who contract for this service is $1,150.41 with a
median of $975.00.
Table 2: Specialty Per Diem Services Rates
MH FFS All Other Payors
Category Type Minimum Maximum Average Median
Specialty Inpatient IP $1,936.21 $1,010.68 $1,938.00 $1,652.02 $1,936.21
Psychiatric Service
for
Children/Adolescents
with
Neurodevelopmental
Disorders Per Diem
Payment
Specialty Inpatient IP $1,500 $957.60 $1,500 $1,284.26 $1,500.00
Psychiatric Service
for Eating Disorder
Per Diem Payment
Table 2 depicts the rate differential for Specialty Inpatient Per Diem payments in FFS in comparison to
the MCE rates. There are currently two Specialty Inpatient Per Diem Rates for inpatient psychiatric
hospitals: 1) Specialty Inpatient Per Diem Rate for Psychiatric Services for Children/Adolescents with
Neurodevelopmental Disorders; and 2) Specialty Inpatient Per Diem Rate for Psychiatric Services for
Eating Disorders Treatment.
As noted in the above table, the MCE per diem rate for Specialty Inpatient Psychiatric Service for
Children/Adolescents with Neurodevelopmental Disorders ranges from a minimum of $1,155.69 to a
maximum of $1,938.00 with an average rate of $1,682.85 and a median of $1,936.21. The FFS Specialty
Inpatient Psychiatric Service for Eating Disorders minimum rate is $957.60 and the maximum rate is
$1,500. The average rate among MCEs who contract for this service is $1,140.44, with a median of
$963.72.
Table 3: Substance Abuse Treatment Hospital Rates (Per Diem) reported as of December 2023
MH FFS All Other Payors
Age Group Type Minimum Maximum Average Median
All SUD $908.35 $436.00 $1,897.00 $887.96 $908.35
Table 3 depicts the substance abuse treatment hospital (SATH) per diem rates for MassHealth FFS in
comparison to the MCE rates. The current MassHealth FFS SATH per diem rate is $908.35.
As noted in the table above, the MCE rates range from a minimum of $436 to a maximum of $1,897, with
an average for all MassHealth MCEs of $887.96 and a median of $908.35.
Please feel free to contact Sarah Nordberg at Sarah.Nordberg@mass.gov should you have any questions
about this report.
Sincerely,
Mike Levine
cc: Kathleen E. Walsh