For health care services provided to medical assistance recipients through the executive office of health and human services' managed care delivery systems, including a behavioral health contractor, the Primary Care Clinician Plan, Primary Care Accountable Care Organizations, MassHealth managed care organizations and Accountable Care Partnership Plans and for MassHealth benefits provided to children, adolescents and adults under
section 9 of chapter 118E of the General Laws and clauses (a) to (d), inclusive, and clause (h) of subsection (2) of
section 9A of said chapter 118E and
section 16C of said chapter 118E; provided, that no funds shall be expended from this item for children and adolescents under clause (c) of said subsection (2) of said
section 9A of said chapter 118E whose household incomes, as determined by the executive office, exceed 150 per cent of the federal poverty level; provided further, that funds may be expended from this item for health care services provided to recipients in prior fiscal years; provided further, that in fiscal year 2026, the executive office shall expend not less than $13,750,000 more for primary care than in fiscal year 2025; provided further, that in fiscal year 2026, the executive office shall expend not less than $5,273,500 more for outpatient behavioral health and addiction services rates than in fiscal year 2025; provided further, that the executive office shall require that any contract or other arrangement entered into by a managed care provider under the managed care delivery system for the provision and administration of pharmacy benefit management services on behalf of individuals enrolled in programs of medical assistance under this item, including a managed care provider participating in an accountable care partnership plan, shall include, but not be limited to, the requirement that pharmacy benefit managers: (i) identify all sources and amounts of income, payments and financial benefits related to the provision and administration of pharmacy benefit management services on behalf of the managed care provider including, but not limited to, pricing discounts, rebates, inflationary payments, credits, clawbacks, fees, grants, chargebacks, reimbursements or other benefits; and (ii) disclose to MassHealth the sources and amounts of all income, payments and financial benefits received by the pharmacy benefit manager; provided further, that not later than February 6, 2026, the executive office shall submit a report to the house and senate committees on ways and means detailing: (a) the total number of members participating in the Accountable Care Organization program; (b) disenrollment trends from the Partnership Plan, Primary Care Accountable Care Organization and Managed Care Organization--administered Accountable Care Organizations within the designated plan selection; (c) the outcomes achieved by accountable care organizations and community partners including, but not limited to, financial performance, patient safety, patient satisfaction, quality and aggregate and per--member reductions in spending compared to prior cost trends; (d) the results of benchmarks on accountable care organizations' and community partners' progress toward an integrated care delivery system; and (e) a summary of spending and activities related to traditionally non--reimbursed services to address health--related social needs including, but not limited to, home and community--based services, housing stabilization and support, utility assistance, non--medical transportation, physical activity, nutrition, sexual assault and domestic violence supports; provided further, that said summary shall include, to the maximum extent practicable, aggregated data on the results of preventative health care services, including health--related social needs screening, the number of referrals to human service providers to address such screening, the result of such referrals and changes in health status; provided further, that such data shall be stratified by demographic factors to support an analysis of the impact on health disparities; provided further, that where data is not available, a report on progress toward establishing necessary data systems shall be provided; provided further, that said summary shall include outcome measures for at--risk populations with chronic health conditions; and provided further, that not later than March 6, 2026, the executive office shall conduct and submit a comparative analysis to the house and senate committees on ways and means and the joint committee on mental health, substance use and recovery of the rate differential for inpatient psychiatric and substance use hospital per diem payments between MassHealth and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third--party administrators under contract to a Medicaid managed care organization or primary care clinician plan
