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.

Uniform dollar increase for children’s inpatient and outpatient services with recognized children’s hospitals established by the state for rating periods covering September 1,2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term amount of up to $1,229,000.

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, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.

A uniform dollar increase established by the state for eligible public and government-owned emergency medical transport providers for the rating period covering July 1, 2024through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $5.08 million.

Uniform increase established by the state for emergency medical transport services provided by public and government-owned or operated ambulance service providers for rating periods covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term amount of up to $13,062,198.

Uniform increase established by the state for emergency medical transport services provided by ground non-governmental ambulance services providers for rating periods covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term amount of up to $16,226,538.

Uniform increase established by the state for dispensing fees for Independent Community Pharmacies for the rating period covering July 1, 2025 through June 30,2026, incorporated in the capitation rates through a separate payment term of up to$9,500,000.

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.