Approved State Directed Payment Preprints

Quality incentive program for inpatient hospital services, outpatient hospital services, primary care services, and specialty physician services at Nemours Children’s Hospital for the rating period covering January 1, 2025 through December 31, 2027, incorporated in the capitation rates through a risk-based rate adjustment.

Uniform increase for professional services at an academic medical center provided by Qualified Licensed Professionals as established by the state for the rating period, January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term up to $16,000,000.

Pay for performance arrangement established by the state for public and private hospitals as defined in the preprint for the rating period covering January 1, 2025 through December 31, 2025 incorporated in the capitation rates through a separate payment term of up to $103.5 million; Uniform dollar increase established by the state for safety net hospitals owned and operated by a government agency for the rating period covering January 1, 2025 through December 31, 2025 incorporated in the capitation rates through a separate payment term of up to $78.47 million; Uniform percentage increase established by the state for inpatient and outpatient hospital services within privately-owned hospital provider classes for the rating period covering January 1, 2025 to December 31, 2025 incorporated in the capitation rates through a separate payment term of up to $241.69 million; and,
Minimum and Maximum fee schedule established by the state for in-state general acute hospitals and children’s hospital services within in-state general acute hospital provider classes for the rating period of January 1, 2025 to December 31, 2025 incorporated in the capitation rates through a risk-based adjustment.
 

Uniform increase established by the state for inpatient and outpatient services at hospitals participating in delivery system transformation programs approved by the state for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $190,000,000.

Uniform increase established by the state for inpatient labor and delivery services at Safety Net hospitals for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $50,000,000.

Uniform dollar increase for nursing facilities based on quality weighted Medicaid days for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $70 million.

Uniform increase for critical access hospitals established by the state for outpatient hospital services for the rating period, January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term up to $13,500,000.

Pay for performance arrangement established by the state for public and private nursing facilities as defined in the preprint for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $2.8 million; and, Uniform dollar increase established by the state for nursing facility services within government-owned nursing facilities for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $17.86 million.
 

Minimum fee schedule for psychiatric services for enrollees under the age of 21 with Autism Spectrum Disorder or Intellectual or Developmental Disability (ASD/IDD) for the rating period covering January 1, 2023 through September 30, 2023, provided by the state’s Prepaid Inpatient Health Plan (PIHP), incorporated in the capitation rates through a risk-based rate adjustment.

Uniform percentage increase established by the state for personal care service claims for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.