MedicaidAdministrativeMedium impact
Managed Care Entity Bulletin 123: Primary Care Sub-Capitation Tier Requirement Updates
MassHealth·MA · Family Medicine, Internal Medicine, General Practice +1 more·Managed Care
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
MassHealth updated Primary Care Sub-Capitation tier requirements for Contract Year 2026, affecting ACPPs and PCACOs. All participating primary care practices must submit new tier designation attestations by spring 2025, even if not changing tiers.
Action Required
By spring 2025: Primary care practices participating in MassHealth ACO programs must complete new Practice Tier Designation Attestation forms for 2026. Billing teams should coordinate with practice administrators to ensure compliance with updated tier criteria including oral health screenings, behavioral health screenings, and care delivery requirements. ACOs must collect and maintain updated attestations for all network practices.