Budget Amendment ID: FY2026-S3-157

ECO 157

Community Health Center Reimbursement Rate Floor

Ms. Friedman, Messrs. Cyr, Mark, Oliveira, Gómez and Payano, Ms. Rausch, Messrs. Lewis, O'Connor and Collins, Ms. Miranda, Messrs. Eldridge, Cronin, Keenan, Driscoll and Kennedy, Ms. Edwards and Ms. Lovely moved that the proposed new text be amended in section 2, in item 7006-0020, by adding the following words:- “; provided further, the rate of payment for any federally qualified health center services provided to a patient by a community health center shall be reimbursed in an amount not less than equivalent to the annual aggregate revenue that the health center would have received if reimbursed by MassHealth pursuant to methodology that conforms with 42 U.S.C. § 1396a(bb) and 1396b(m)(2)(A)(ix), as appearing in Title 42 of the United States Code as of January 1, 2026; provided further, any entity licensed by the division of insurance and providing reimbursement to federally qualified health centers for services provided to patients, including, but not limited to, non-profit hospital service corporations, medical service corporations, dental service corporations, health maintenance organizations and preferred provider organizations or any other entity not specifically enumerated hereunder licensed by the division of insurance and providing reimbursement to federally qualified health centers for services provided to patients, shall submit an annual report to the division of insurance as a condition of their licensure evidencing that the total reimbursement to federally qualified health centers for services provided to patients in the prior year was equivalent to the annual aggregate revenue the health center would have received if reimbursed by MassHealth; provided further, the division of insurance shall consult with MassHealth to receive technical assistance regarding the per visit payment rate for each federally qualified health center for a given year; provided further, MassHealth shall provide the division of insurance with a proxy rate for any federally qualified health center who has not received an individual prospective payment system rate and the division of insurance shall make available to health plans upon request the necessary prospective payment system rate information regarding their contracted federally qualified health centers so that the health plan can ensure compliance with this requirement”.