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 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 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, 2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term amount of up to $3,118,148.

Uniform percentage increase established by the state for behavioral health outpatient services for Medicaid-enrolled managed care enrollees delivered by PACT teams (Program of Assertive Community Treatment) for the rating period covering January 1, 2025, through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.

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 increase established by the state for emergency medical transport services provided by ground non-governmental ambulance services providers for rating periods covering July 1, 2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term amount of up to $8,183,729.

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.

Uniform dollar increase established by the state for inpatient hospital services, primary care services, and specialty physician services for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term of up to $6,603,083.

The uniform dollar increase for inpatient discharges and outpatient visits to qualifying non-critical access hospitals for the rating period covering September 1, 2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term of up to $32,413,757.

Uniform dollar increase for government-owned or operated ground ambulance providers for the rating period covering July 1, 2024, through June 30, 2025, incorporated in the capitation rates through a separate payment term amount of up to $80,253,305.