Approved State Directed Payment Preprints

Uniform percentage increase for inpatient hospital and outpatient hospital services for rating periods covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term amount up to $1,908,259,031.

Uniform dollar increase, quality payment, and population-based payment for primary care services for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment up to$51,700,000.

The value based payment arrangement for the Behavioral Health Quality Incentive for the rating period covering January 1, 2025 to December 31, 2027, incorporated in the capitation rates through a separate payment term of up to $72 million for January 1, 2025–December 31, 2025; $72 million for January 1, 2026 – December 31, 2026; and $72 million for January 1, 2027 – December 31, 2027.

Performance improvement initiative for community behavioral health center services for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term amount up to $15,497,672.

Uniform dollar increase established by the state for inpatient and outpatient hospital services at eligible critical access, acute, and rehabilitation hospitals for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term amount up to $2,269,269,993.

Uniform percentage increase for inpatient hospital services and outpatient hospital services for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term amount up to $453,391,741.

The uniform dollar increase established by the state for direct care workers providing personal care services to eligible enrollees for the rating period covering January 1, 2026through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment.

Uniform dollar increase for psychiatric inpatient days for the rating period covering October 1, 2025 through September 30, 2026, incorporated in the capitation rates through a separate payment term up to $297,800,000.

Population-based payment established by the state for Medicaid managed care enrollees attributed to eligible primary care providers who have active New York State Patient Centered Medical Home (PCMH) recognition and have attested to developing a referral workflow with regional Social Care Networks for the rating period covering April 1, 2026 through March 31, 2027, incorporated in the capitation rates through a separate payment term amount up to $94,541,086.

Uniform percentage increase for inpatient and outpatient hospital services for the rating period covering February 1, 2025 through September 30, 2025, incorporated in the capitation rates through a risk-based rate adjustment amount up to$217,671,953.