Rates of Payment

(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 applies when such methodology is compatible with the MassHealth agency's claims-processing system. Otherwise, the MassHealth agency and the out-of-state facility 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.