Approved State Directed Payment Preprints

Performance Improvement Initiative, Value-Based Purchasing Model, and Uniform Percentage Increase for inpatient hospital services and outpatient hospital services for the rating period covering February 1, 2025 through September 30, 2025, incorporated in the capitation rates through a separate payment term amount up to $5,413,222,576.

Performance Improvement Initiative, Value-Based Purchasing Model, and Uniform Percentage Increase for inpatient hospital services and outpatient hospital services for the rating period covering October 1, 2024 through January 31, 2025, incorporated in the capitation rates through a separate payment term up to $2,470,111,272.

Uniform increase and value-based payment arrangement established by the state to implement the Healthcare Delivery Access Act for inpatient and outpatient hospital services for the rating period January 1, 2026 through December 31, 2026, incorporated into the capitation rates through a separate payment term up to $1.5 billion.

Uniform Percentage Increase for professional services at an academic medical center 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 $31,002,486.

Uniform increase for inpatient and outpatient hospital services and behavioral health inpatient and outpatient services 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 $725,112,312.

Quality Payment/Pay for Performance (Category 2 APM, or similar) and Performance Improvement Initiative for nursing facility services for rating periods covering January1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term amount of up to $15,000,000.

Uniform dollar increase established by the state for inpatient hospital services, primary care services, and specialty physician services for the rating period covering July 1, 2025through June 30, 2026, incorporated into the capitation rates through a separate payment term amount of up to $6,603,083.

Quality Payment/Pay for Performance (Category 2 APM, or similar) for inpatient and outpatient hospital services for the rating period covering July 1, 2025 through June 30,2026, incorporated into the capitation rates through a separate payment term in the amount of $233,573,938.

Value Based Payment to meet or exceed the performance measure benchmarks on specific provider quality metrics for outpatient hospital services to receive incentive payments for the rating period covering January 1, 2026 through December 31, 2027 for a multi-year period, incorporated in the capitation rates through a separate payment term of up to $60,000,000.

Uniform percentage increase for hospitals owned and operated by or operated by a state university established by the state for inpatient and outpatient hospital services for the rating period, January 1, 2026 through December 31, 2026, incorporated into the capitation rates through a separate payment term up to $480,400,000.