26PMEHSACUTEHOSPITAL: Rate Year 2026 Acute Hospital Request for Applications

The Massachusetts Executive Office of Health and Human Services (EOHHS) Office of Medicaid is issuing a Rate Year 2026 (RY26) Request for Applications (RFA) to solicit applications from eligible in-state acute hospitals seeking to participate as MassHealth Providers. The procurement covers comprehensive inpatient and outpatient hospital services to be provided between October 1, 2025, and September 30, 2026, including services across hospital inpatient departments, outpatient departments, emergency departments, and satellite clinics. Hospitals will be evaluated on quality metrics spanning four core domains: Care Coordination, Care for Acute and Chronic Conditions, Patient Safety, and Patient Experience, with potential to earn incentive payments up to $250 million based on performance. Key deadlines include an applicants' conference scheduled for September 9, 2025, with prospective applicants permitted to submit written questions to Jin Pantano no later than September 12, 2025, at 5:00 p.m. The complete RFA submissions, including all required documentation, must be submitted by September 30, 2025, at 5:00 p.m., following the instructions outlined in Section 9.B of the RFA document.

Hospitals must meet specific eligibility criteria to participate, including being Medicare-certified, located in Massachusetts, and having more than 50% of beds in specified categories. The procurement includes a comprehensive reimbursement methodology with multiple payment structures, such as Adjudicated Payment Amount per Discharge (APED) and Adjudicated Payment per Episode of Care (APEC), with total supplemental payment programs approximating $480 million. Additional supplemental payments are available for high public payer hospitals, essential hospitals, and hospitals with high Medicaid volumes, with specific allocations designated for inpatient and outpatient services. While the documentation does not specify set-aside designations for disadvantaged enterprises, the RFA appears focused on in-state acute care hospitals that can demonstrate capability to serve MassHealth members. The procurement represents a significant investment in Massachusetts healthcare infrastructure, with potential contract values and supplemental payments totaling approximately $730 million when combining base reimbursement and performance incentive funds.