Other Payment Provisions

(1) Temporary Resident Add-on. (a) For dates of service beginning October 1, 2022, a nursing facility will be eligible for a member-specific temporary resident add-on if the resident meets all of the following criteria: 1. MassHealth is the resident’s primary payer for nursing facility services at the time of admission; 2. the resident is medically eligible for nursing facility services under 130 CMR 456.409: Services Requirement for Medical Eligibility; 3. the resident was transferred to the nursing facility for temporary residence purposes directly from their home; and 4. the resident was discharged from the nursing facility to their home within 30 calendar days of the admission date. (b) Payment Amount. For individuals younger than 22 years old, the add-on is $250 per member per day. For individuals 22 years of age or older, the add-on is $130 per member per day. (2) Ventilator Add-on. For dates of service beginning October 1, 2024 a nursing facility that provides ventilator services to ventilator-dependent MassHealth members will receive a member- specific ventilator add-on of $343 per member per day, provided all of the following criteria are met: (a) MassHealth is the resident’s primary payer for nursing facility services at the time of admission; (b) The resident requires ventilator services at least daily; (c) The facility is approved by EOHHS to provide specialized ventilator-dependent services, in accordance with processes established through administrative bulletin or other written issuance; (d) The facility maintains a program for specialized ventilator services, in accordance with MassHealth requirements established through administrative bulletin or other written issuance; and (e) The facility is not receiving the communication-limited resident ventilator add-on described in 101 CMR 206.10(3) or the tracheostomy add-on described in 101 CMR 206.10(6) for the resident. (3) Communication-limited Resident Ventilator Add-on. For dates of service beginning October 1, 2024 a nursing facility that provides services to ventilator-dependent MassHealth members will receive a member-specific add-on of $457 per member per day, provided all of the following criteria are met: (a) MassHealth is the resident’s primary payer for nursing facility services at the time of admission; (b) The resident requires ventilator services at least daily and is unable to communicate without the assistance of specialized communication technology that relies on eye movements, such as certain individuals with advanced amyotrophic lateral sclerosis (ALS); (c) The facility is approved by EOHHS to provide specialized ventilator-dependent services, in accordance with processes established through administrative bulletin or other written issuance; (d) The facility maintains a program for specialized ventilator services, in accordance with MassHealth requirements established through administrative bulletin or other written issuance; and (e) The facility is not receiving the ventilator add-on described in 101 CMR 206.10(2) or the tracheostomy add-on described in 101 CMR 206.10(6) for the resident. (101 CMR 206.10(4) through (5) Reserved) (6) Tracheostomy Add-on. For dates of service beginning October 1, 2022, a nursing facility that provides tracheostomy services to tracheostomy-dependent MassHealth members will receive a member-specific tracheostomy add-on of $220 per member per day, provided all of the following criteria are met: (a) MassHealth is the resident’s primary payer for nursing facility services at the time of admission; (b) the resident requires tracheostomy services; and (c) the facility is not receiving the ventilator add-on described in 101 CMR 206.10(2) or the communication-limited resident ventilator add-on described in 101 CMR 206.10(3) for the resident. (7) Medicaid Transitional Add-on. For dates of service beginning January 15, 2022, a nursing facility will be eligible for a transitional add-on of $200 per member per day for the first 60 days of the resident’s nursing facility stay, not including any leaves of absence, if the resident meets all of the following criteria: (a) MassHealth is the resident’s primary payer for nursing facility services at the time of admission; (b) The resident was transferred to the nursing facility directly from an acute or a non-acute inpatient hospital on or after January 15, 2022; and (c) The resident is not returning to the nursing facility from a medical leave of absence. (8) COVID-19 Monoclonal Antibody Treatment and COVID-19 Antiviral Treatment Claims. (a) For dates of service beginning December 22, 2021, and notwithstanding any regulatory provision to the contrary, nursing facilities may submit separate claims to MassHealth on a fee- for-service basis for the administration of COVID-19 monoclonal antibody treatments and COVID-19 antiviral treatments to eligible MassHealth members and provided in a manner supported by medical evidence, provided in accordance with the emergency use authorization (EUA) issued by the federal Food and Drug Administration (FDA) or provided in accordance with full FDA approval, and provided in accordance with any guidance issued by DPH, the FDA, or CMS with respect to such treatments. Nursing facilities are required to ensure that any such monoclonal antibody treatments or antiviral treatments administered at the facility are administered by individuals whose education, credentials, and training qualify them to render such services. (b) The costs of services described in 101 CMR 206.10(8)(a) are not included in the prospective payment system operating or nursing standard payment rates determined under 101 CMR 206.03 and 101 CMR 206.04. The costs of providing such services will be considered non-allowable costs under 101 CMR 206.08(3)(h)(12). (c) MassHealth payments for separate fee-for-service claims submitted by the nursing facility for the services described in 101 CMR 206.10(8)(a) must be paid at the rates established under 101 CMR 446.03(2) or 101 CMR 317.00, as applicable. Such fee-for-service claims payments must be considered payment in full for such services. (d) EOHHS must establish, through administrative bulletin or other written issuance, the specific COVID-19 monoclonal antibody treatments or COVID-19 antiviral treatments that may be administered by the nursing facility, as well as the specific codes and billing instructions for such services. (9) COVID-19 Vaccine Administration Claims. (a) For dates of service beginning October 1, 2021, and notwithstanding any regulatory provision to the contrary, nursing facilities may submit separate claims to MassHealth on a fee-for-service basis for COVID-19 vaccine administration services, provided to eligible MassHealth members in accordance with an EUA issued by the FDA or full FDA approval, and in accordance with any guidance issued by the FDA or CMS with respect to such services. Nursing facilities are required to ensure that any such services administered by the facility are administered by individuals whose education, credentials, and training qualify them to render such services. (b) The costs of services described in 101 CMR 206.10(9)(a) are not included in the prospective payment system operating or nursing standard payment rates determined under 101 CMR 206.03 and 101 CMR 206.04. The costs of providing such services will be considered non-allowable costs under 101 CMR 206.08(3)(h)12. (c) MassHealth payments for separate fee-for-service claims submitted by the nursing facility for the services described in 101 CMR 206.10(9)(a) must be paid at the rates established under 101 CMR 446.03(2): Medicine. Such fee-for-service claims must be considered payment in full for such services. (d) EOHHS must establish, through administrative bulletin or other written issuance, the specific codes and billing instructions for such services. (101 CMR 206.10(10) through (12) Reserved) (13) Homelessness Rate Add-on. (a) Eligibility Criteria. For dates of service beginning January 15, 2022, a nursing facility will be eligible for a member-based homelessness rate add-on of $200 per member per day for up to the first 180 days of the member’s nursing facility stay, not including any leaves of absence, if the member meets all of the following criteria. 1. MassHealth is the member’s primary payer for nursing facility services at the time of admission; 2. The member is clinically eligible for nursing facility services under 130 CMR 456.409: Services Requirement for Medical Eligibility; and 3. The member has been approved for the member-based homelessness rate add-on by EOHHS because EOHHS has determined the member meets one or more of the following criteria: a. The member has experienced homelessness for at least six months directly prior to admission as documented by a homeless provider agency and confirmed by EOHHS; b. The member has been homeless directly prior to admission, as documented by a homeless provider agency and confirmed by EOHHS, and has a behavioral health condition; c. The member is at risk of homelessness and has a behavioral health condition; d. The member experienced a sudden or unexpected loss of primary residence (for example, due to fire, flooding, eviction, etc.) necessitating an emergency nursing facility admission; or e. The member’s living situation directly prior to admission required the involvement of Elder Protective Services. (b) Non-applicability with Other Payments. A nursing facility may not receive this add-on for a member for whom the facility is receiving on the same dates of service a Medicaid transitional add-on under 101 CMR 206.10(7), a substance use disorder add-on or a substance use disorder induction period add-on under 101 CMR 206.10(14), a behavioral indicator add-on under 101 CMR 206.10(16), a bariatric add-on under 101 CMR 206.10(21), a per diem rate for severe mental or neurological disorders under 101 CMR 206.11, a temporary resident add-on under 101 CMR 206.10(1), or a complicated high-cost care need add-on under 101 CMR 206.15. (c) Relevant Definitions. 1. For the purposes of the homelessness rate add-on, a member experiencing homelessness is any member who lacks a fixed, regular, and adequate nighttime residence and who has a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings including a car, park, abandoned building, bus or train station, airport, or camping group; or who is living in a supervised publicly- or privately-operated emergency shelter designated to provide temporary living arrangements, including congregate shelters, transitional housing, and hotels and motels paid for by charitable organizations or by federal, state, or local government programs for low-income individuals. 2. For the purposes of the homelessness rate add-on, a member at risk of homelessness is any member who does not have sufficient resources or support networks (e.g., family, friends, faith-based or other social networks) immediately available to prevent them from moving to an emergency shelter or another place not meant for human habitation. (14) Substance Use Disorder (SUD) Add-on and SUD Induction Period Add-on. (a) Eligibility Criteria. 1. For dates of service beginning October 1, 2024, a nursing facility that meets the criteria set forth in 101 CMR 206.10(14)(a)(3) or (4), as applicable, will be eligible for a member specific Substance Use Disorder (SUD) add-on of $50 per member per day for each member residing in the facility, for whom MassHealth is the primary payer, who has a documented SUD diagnosis listed in 101 CMR 206.10(14)(b) and who receives at least one SUD service or treatment listed in 101 CMR 206.10(14)(c). 2. For dates of services beginning October 1, 2024, a nursing facility that meets the criteria set forth in 101 CMR 206.10(14)(a)(3) or (4), as applicable, will be eligible for a member specific SUD induction period add-on of $200 per member per day of induction period for each member residing in the facility, for whom MassHealth is the primary payer, who has a documented SUD diagnosis listed in 101 CMR 206.10(14)(b), and who requires transportation with direct care staff to an Opioid Treatment Program (OTP) clinic for the member’s induction period. 3. The facility will be eligible to receive the add-ons under 101 CMR 206.10(14)(a)(1) and (2) only if it submits to EOHHS an attestation in a form and manner specified by EOHHS by the deadline specified by EOHHS regarding the facility’s policies and procedures to provide services to residents with SUD. This provision applies to all facilities unless they are a High-SUD nursing facility as described in 101 CMR 206.10(14)(a)(4). 4. A facility that meets the criteria for a High-SUD nursing facility, as determined by EOHHS, will be eligible to receive the add-ons under 101 CMR 206.10(14)(a)(1) and (2) only if: a. The facility submits to EOHHS an attestation in a form and manner specified by EOHHS by the deadline specified by EOHHS regarding the facility’s policies and procedures to provide services to residents with SUD; and b. The facility submits to EOHHS: (1) an attestation in a form and manner specified by EOHHS by the deadline specified by EOHHS, certifying that the facility has executed an appropriate agreement to share data and collaborate with at least one OTP. Such agreement must include agreed-upon policies and procedures for collaboration with the OTP as specified by EOHHS in administrative bulletin or other written issuance; and (2) a copy of the executed agreement. (b) ICD-10 Groups. For the purposes of the SUD add-on and the SUD induction period add- on, eligible ICD-10 diagnosis groups include F10 through F16 (mental and behavioral disorders due to psychoactive substance), F19 (other psychoactive substance related disorders), and T40 (poisoning by, adverse effect of and underdosing of narcotics and psychodysleptics (hallucinogens)). (c) SUD Services or Treatment. For the purposes of the SUD add-on and the SUD induction period add-on, eligible SUD services or treatment include opioid use disorder counseling, in individual or group format; medication management for medications for opioid use disorder treatment; other SUD related counseling, in individual or group format; or medication management for medications for other SUD treatment. (d) Denial of Payment and Overpayments. Facilities that fail to meet the requirements under 101 CMR 206.10(14)(a), (b), or (c) may be denied further SUD add-on payments and may be subject to overpayment action under 130 CMR 450.237: Overpayments: Determination. In addition, facilities that refuse to admit a resident with SUD solely because of their SUD diagnosis may be denied the SUD add-on for the rest of the rate year and may be subject to sanctions under 130 CMR 450.238: Sanctions: General. (e) Additional Guidance. EOHHS may issue, via administrative bulletin or other written issuance, additional guidance regarding these add-ons, including but not limited to guidance on billing procedures and verification of medical records required to support the SUD diagnoses. (15) Add-on for Home Dialysis in a Nursing Facility Setting. (a) Dialysis Treatment for Members. Nursing facilities may have home dialysis services available on-site at the facility, after receiving approval from the Department of Public Health to operate an on-site home dialysis services program, in coordination with a licensed dialysis services provider. (b) Add-on Rate of $85 per Member per Dialysis Treatment. Nursing facilities with an approved on-site home dialysis services program in accordance with 101 CMR 206.10(15)(a) may receive a rate add-on of $85 per member residing in the facility and receiving home dialysis services in the facility, for each instance of home dialysis services received in the nursing facility for which the following two conditions are concurrently met: 1. MassHealth is not the primary payer for the member’s home dialysis services received in the nursing facility; and 2. MassHealth is the primary payer for the member’s nursing facility services at the time of home dialysis services received in the nursing facility. (c) Add-on Rate of $379 per Member per Dialysis Treatment. Nursing facilities with an approved on-site home dialysis services program in accordance with 101 CMR 206.10(15)(a) may receive a rate add-on of $379 per member residing in the facility and receiving home dialysis services in the facility, for each instance of home dialysis services received in the nursing facility for which the following two conditions are concurrently met: 1. MassHealth would be the primary payer for the dialysis services if they were received outside of the nursing facility; and 2. MassHealth is the primary payer for the member’s nursing facility services at the time of home dialysis services received in the nursing facility. (16) Behavioral Indicator Add-on. (a) Eligibility Criteria. For dates of service beginning October 1, 2022, a nursing facility will be eligible for a member-specific behavioral indicator add-on of $50 per member per day for each member residing in the facility for whom MassHealth is the primary payer and who was coded as 2 or 3 on one or more of the following Minimum Data Set 3.0 (MDS 3.0) indicators: Behavioral Health (E0200A, E0200B, or E0200C), Rejection of Care (E0800), or Wandering (E0900). For dates of service beginning October 1, 2025, a nursing facility will be eligible for a member-specific behavioral indicator add-on of $45 per member per day for each member residing in the facility for whom MassHealth is the primary payer and who was coded as 2 or 3 on one or more of the following Minimum Data Set 3.0 (MDS 3.0) indicators: Behavioral Health (E0200A, E0200B, or E0200C); Rejection of Care (E0800); or Wandering (E0900). The add-on is meant to offset additional costs associated with certain members with behavioral conditions (for example, members with severe dementia). (b) Additional Guidance. EOHHS may issue, via administrative bulletin or other written issuance, additional guidance regarding this add-on, including but not limited to billing procedures for the behavioral indicator add-on and verification of medical records required to support the MDS coding for the add-on. (c) Denial of Payment and Overpayments. Facilities that fail to meet the requirements under 101 CMR 206.10(16)(a) or (b) may be denied further behavioral indicator add-on payments and may be subject to overpayment action under 130 CMR 450.237: Overpayments: Determination. In addition, facilities that refuse to admit a resident with behavioral health needs solely because of their behavioral health needs may be denied the behavioral indicator add-on for the rest of the rate year and may be subject to sanctions under 130 CMR 450.238: Sanctions: General. (17) Add-on for Dialysis Services Provided at an Affiliated Inpatient Chronic Disease and Rehabilitation Hospital (a) Dialysis Treatment for Members. Nursing facility residents may receive dialysis services at an affiliated inpatient chronic disease and rehabilitation hospital that is licensed by DPH and located in the same building. If the dialysis services are licensed by DPH as services provided by an outpatient clinic in accordance with 105 CMR 145.000, the nursing facility may not receive the rate add-on under 101 CMR 206.10(17). (b) Add-on Rate of $85 per Member per Dialysis Treatment. Nursing facilities may receive a rate add-on of $85 per member residing in the nursing facility and receiving dialysis services in a setting that meets the criteria specified in 101 CMR 206.10(17)(a) for each instance of dialysis services received in the affiliated facility for which the following two conditions are concurrently met: 1. MassHealth is not the primary payer for the member’s dialysis services received in the affiliated facility; and 2. MassHealth is the primary payer for the member’s nursing facility services at the time of dialysis services received in the affiliated facility. (c) Add-on Rate of $379 per Member per Dialysis Treatment. Nursing facilities may receive a rate add-on of $379 per member residing in the nursing facility and receiving dialysis services in a setting that meets the criteria specified in 101 CMR 206.10(17)(a), for each instance of dialysis services received in the affiliated facility for which the following two conditions are concurrently met: 1. MassHealth would be the primary payer for the dialysis services if they were received outside of the nursing facility; and 2. MassHealth is the primary payer for the member’s nursing facility services at the time of dialysis services received in the affiliated facility. (18) Payments for Quality Improvements through COVID-19 Preparedness. (a) General. A nursing facility will be eligible for a COVID-19 preparedness payment, as calculated in 101 CMR 206.10(18)(c), to be made upon verification of eligibility criteria described in 101 CMR 206.10(18)(b). (b) Eligibility Criteria. A nursing facility will be eligible for a COVID-19 preparedness payment if the facility meets all of the criteria in 101 CMR 206.10(18)(b)1. through 5. MassHealth may provide further detail on such criteria, including on the specific infection control requirements, attestation forms and deadlines, any necessary reporting deadlines, specific requirements for COVID-19 therapeutic plans, and other information as MassHealth determines necessary pursuant to 101 CMR 206.10(18)(f). 1. The nursing facility a. had an HPPD, as defined in 101 CMR 206.13(3), of 3.58 or higher for at least one calendar quarter from October 1, 2022, through December 31, 2024; or b. achieved a minimum of 10% improvement in HPPD in at least one calendar quarter from January 1, 2023, through December 31, 2024, as compared to the calendar quarter ending December 31, 2022. 2. The nursing facility meets a minimum threshold of staff and residents who are up-to- date with COVID-19 vaccinations, with thresholds and deadlines established by MassHealth through administrative bulletin or other written issuance. 3. The nursing facility must attest to implementing core components of infection control requirements and outline a plan for ensuring compliance with these requirements and be in continuous substantial compliance with such requirements during the rate year. 4. A nursing facility must attest to having a plan in place to administer COVID-19 therapeutics, including monoclonal antibodies and antiviral therapies, to its residents as clinically appropriate. 5. The nursing facility must meet the 75% DCC-Q threshold established under 101 CMR 206.12(1). (c) Payment Methodology. EOHHS will use the following methodology to calculate COVID-19 preparedness payments for each eligible nursing facility. 1. Determine the total number of Massachusetts Medicaid days, including fee-for-service (FFS) days and managed care days, as reported by eligible nursing facilities in their Quarterly User Fee Assessment Forms for the period of July 1, 2021, through June 30, 2022. 2. Determine which of the two thresholds of staff and residents who are up-to-date with COVID-19 vaccinations a nursing facility meets. 3. If the facility meets the higher of the two thresholds in 101 CMR 206.10(18)(c)2., multiply by 3 the number of Massachusetts Medicaid days, including fee-for-service (FFS) days and managed care days, as reported by an eligible nursing facility in its Quarterly User Fee Assessment Forms for the period of July 1, 2021, through June 30, 2022. 4. If the facility meets the lower of the two thresholds in 101 CMR 206.10(18)(c)2., keep the same the number of Massachusetts Medicaid days, including fee-for-service (FFS) days and managed care days, as reported by an eligible nursing facility in its Quarterly User Fee Assessment Forms for the period of July 1, 2021, through June 30, 2022. 5. Sum up Massachusetts Medicaid days in 101 CMR 206.10(18)(c)3. and 101 CMR 206.10(18)(c)4. 6. Divide the total amount of available funds, $16,550,000, by the total number of Massachusetts Medicaid days as determined in 101 CMR 206.10(18)(c)5. 7. For each eligible nursing facility meeting the higher of the two thresholds in 101 CMR 206.10(18)(c)2., multiply the quotient calculated in 101 CMR 206.10(18)(c)6. by the eligible nursing facility’s Massachusetts Medicaid days, as calculated in 101 CMR 206.10(18)(c)3. 8. For each eligible nursing facility meeting the lower of the two thresholds in 101 CMR 206.10(18)(c)2., multiply the quotient calculated in 101 CMR 206.10(18)(c)6. by the eligible nursing facility’s Massachusetts Medicaid days, as they appear in 101 CMR 206.10(18)(c)4. 9. If the product in 101 CMR 206.10(18)(c)7. is greater than $700,000, cap the total calculated for each eligible nursing facility at $700,000; otherwise keep the total as is. 10. If the product in 101 CMR 206.10(18)(c)8. is greater than $300,000, cap the total calculated for each eligible nursing facility at $300,000; otherwise keep the total as is. 11. Sum up the amounts calculated in 101 CMR 206.10(18)(c)9. and 101 CMR 206.10(18)(c)10. 12. Subtract the sum calculated in 101 CMR 206.10(18)(c)11. from $16,550,000. 13. Sum up Massachusetts Medicaid days for eligible nursing facilities in 101 CMR 206.10(18)(c)4. whose amounts calculated in 101 CMR 206.10(18)(c)10. are less than $300,000. 14. Divide the amount calculated in 101 CMR 206.10(18)(c)12. by the number calculated in 101 CMR 206.10(18)(c)13. 15. For each eligible nursing facility in 101 CMR 206.10(18)(c)4. whose amounts calculated in 101 CMR 206.10(18)(c)10. are less than $300,000, multiply the quotient calculated in 101 CMR 206.10(18)(c)14. by the eligible nursing facility’s Massachusetts Medicaid days, as calculated in 101 CMR 206.10(18)(c)4. 16. For each eligible nursing facility in 101 CMR 206.10(18)(c)4. whose amounts calculated in 101 CMR 206.10(18)(c)10. are less than $300,000, sum up the amount in 101 CMR 206.10(18)(c)10. and the product calculated in 101 CMR 206.10(18)(c)15. 17. If the amount calculated in 101 CMR 206.10(18)(c)16. is greater than $300,000, cap the total calculated for each eligible nursing facility at $300,000; otherwise keep the total as is. 18. Sum up the amounts calculated in 101 CMR 206.10(18)(c)9. and 101 CMR 206.10(18)(c)10. for eligible facilities that reached the $300,000 cap, and in 101 CMR 206.10(18)(c)17. 19. Subtract the sum calculated in 101 CMR 206.10(18)(c)18. from $16,550,000. 20. Repeat the above steps for eligible facilities in 101 CMR 206.10(18)(c)4. whose amounts are less than $300,000 until the remaining funds are fully distributed. 21. The COVID-19 preparedness payments, for each eligible nursing facility, will equal the total calculated in 101 CMR 206.10(18)(c)9., 101 CMR 206.10(18)(c)10., 101 CMR 206.10(18)(c)17., or 101 CMR 206.10(18)(c)20., depending on whether an eligible facility was above or below the allowable cap. (d) Overpayments. A nursing facility that fails to meet the criteria under 101 CMR 206.10(18)(b)1. and/or remain in compliance with all infection control requirements during the period of December 1, 2022, through June 30, 2023, under 101 CMR 206.10(18)(b)4. may be subject to overpayment action under 130 CMR 450.237: Overpayments: Determination. (e) Correction of Material Error. EOHHS may adjust any supplemental payment upon EOHHS’s determination that there was a material error in the calculation of the payment. EOHHS will not adjust any supplemental payment solely because a facility under-reported Massachusetts Medicaid days in its Quarterly User Fee Assessment Form. (f) Additional Guidance. EOHHS may issue, via administrative bulletin or other written issuance, additional guidance regarding this add-on. (101 CMR 206.10(19) through (20) Reserved) (21) Bariatric Add-on. (a) For dates of service beginning on February 2, 2024, nursing facilities may receive a member-based rate add-on of $300 per member per day for each member residing in a facility for whom MassHealth is the primary payer and all of the following conditions are met: 1. prior to the member’s admission, the facility must receive approval from MassHealth to bill the add-on based on the clinical profile of the member; 2. the member has a Body Mass Index (BMI) greater than 40 that can be supported by an ICD-10 code after admission; 3. the member is dependent, as defined by MDS, for at least one activity of daily living that requires a service listed in 130 CMR 456.409(B); and 4. the member requires a minimum of two staff members to assist with transfers, personal care and/or bed mobility. (b) Non-applicability with Other Payments. A nursing facility may not receive this payment for a member for whom the facility is receiving on the same dates of service a homelessness rate add-on under 101 CMR 206.10(13), a severe mental and neurological disorder add-on under 101 CMR 206.11, or a complicated high-cost care need add-on under 101 CMR 206.15. (22) Supplemental Payment for Qualified Nursing Facilities Located near North Adams. (a) Beginning October 1, 2024, a nursing facility located within 17 miles of 71 Hospital Avenue in North Adams, Massachusetts will qualify for a supplemental payment to support additional allowable costs. Each qualified nursing facility will receive a proportional payment of the total amount available of $2,973,456. (b) Qualified nursing facilities will receive a supplemental payment, which will be calculated and determined as follows. 1. Calculate the total of all qualified nursing facilities’ Massachusetts Medicaid days, as reported on quarterly User Fee Assessment Forms for the period April 1, 2023, through March 31, 2024. 2. Determine each qualified nursing facility’s proportion of Massachusetts Medicaid days as a total of all qualified nursing facility Massachusetts Medicaid days. 3. Multiply the proportion of each facility’s Medicaid User Fee days by the total amount available of $2,973,456. (23) Supplemental Payment for Qualified Nursing Facilities Located on Martha’s Vineyard. (a) Beginning October 1, 2025, a nursing facility located within eight miles of Martha’s Vineyard Critical Access Hospital will qualify for a supplemental payment to support additional allowable costs. Each qualified nursing facility will receive a proportional payment of the total amount available of $3,800,000. (b) Qualified nursing facilities will receive a supplemental payment, which will be calculated and determined as follows. 1. Calculate the total of all qualified nursing facilities’ Massachusetts Medicaid days, as reported on quarterly User Fee Assessment Forms for the period April 1, 2024, through March 31, 2025. 2. Determine each qualified nursing facility’s proportion of Massachusetts Medicaid days as a total of all qualified nursing facility Massachusetts Medicaid days. 3. Multiply the proportion of each facility’s Medicaid User Fee days by the total amount available of $3,800,000. (24) Supplemental Payment for Qualified Nursing Facilities (a) Beginning October 1, 2025, a nursing facility with Massachusetts Medicaid days reported on quarterly User Fee Assessment Forms for the period of April 1, 2024, through March 31, 2025, will qualify for a supplemental payment to support additional allowable costs. Each qualified nursing facility will receive a proportional payment of the total amount available of $25,000,000 using the following methodology. 1. Calculate the total of all qualified nursing facilities’ Massachusetts Medicaid days, as reported on quarterly User Fee Assessment Forms for the period of April 1, 2024, through March 31, 2025. 2. Determine each qualified nursing facility’s proportion of Massachusetts Medicaid days as a total of all qualified nursing facilities’ Massachusetts Medicaid days. 3. Multiply the proportion of each facility’s Medicaid User Fee days by the total amount available of $25,000,0000.