Approved State Directed Payment Preprints

Uniform percentage increase established by the state for personal care service claims for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment of up to $14,563,263.

The uniform percentage increase for professional services provided by qualified practitioners affiliated with or employed by an academic medical center, at participating health systems affiliated with a public medical school in the Southwest class established by the state for the rating period January 1, 2025 through December 31, 2025,incorporated into the capitation rates through a risk based adjustment and a separate payment term of up to $1,815,939.75.

A uniform dollar increase established by the state for eligible government-owned emergency medical transport providers for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term of up to $19.46 million.

The uniform percentage increase for professional services provided by qualified practitioners affiliated with or employed by an academic medical center, at participating health systems affiliated with a public medical school in the Northeast class established by the state for the rating period January 1, 2025 through December 31, 2025,incorporated into the capitation rates through a risk based adjustment and a separate payment term of up to $6,804,452.95.

Uniform increase provided by the eligible public safety net hospital established by the state for inpatient and outpatient hospital services for the rating period covering October 1, 2025 through September 30, 2026, incorporated into the capitation rate through a separate payment term of up to $521,990,000.

Minimum Fee Schedule for nursing facility services for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment of up to $235,637,606.

Uniform increase established by the state for eligible inpatient and outpatient hospital services, for the rating period July 1, 2025 through June 30, 2026, incorporated into the capitation rates through a separate payment term of up to $324,718,048.

Uniform increase for in-state, non-rural providers of inpatient and outpatient hospital services, excluding freestanding psychiatric hospitals, freestanding rehabilitation hospitals, and long-term acute care hospitals, for the rating period, July 1, 2025 through June 30, 2026, incorporated into the capitation rates through a separate payment term up to $3,832,329,291.

Uniform increase for in-state, rural providers of inpatient and outpatient hospital services, excluding freestanding psychiatric hospitals, freestanding rehabilitation hospitals, and long-term acute care hospitals, for the rating period, July 1, 2025 through June 30, 2026, incorporated into the capitation rates through a separate payment term up to$314,817,036.

Uniform increase for inpatient and outpatient hospital services by eligible in-state hospital providers of long-term acute care, psychiatric services, and rehabilitation services for the rating period, July 1, 2025 through June 30, 2026, incorporated into the capitation rates through a separate payment term up to $61,455,431.