Approved State Directed Payment Preprints

The value based payment arrangement for the Behavioral Health Quality Incentive for the rating period covering January 1, 2025 to December 31, 2027, incorporated in the capitation rates through a separate payment term of up to $72 million for January 1, 2025–December 31, 2025; $72 million for January 1, 2026 – December 31, 2026; and $72 million for January 1, 2027 – December 31, 2027.

Performance improvement initiative for community behavioral health center services for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term amount up to $15,497,672.

Minimum Fee Schedule for behavioral health outpatient services including 24 hour diversionary substance use disorder services and behavioral health diversionary services for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment.

Primary Care Sub Capitated Arrangement established by the state for the rating period, January 1, 2025 through December 31, 2027, incorporated into the capitation rates through a risk-based adjustment.

Integrated Care Incentive proposal for non-state, public hospitals for the rating periods covering January 2, 2025 to December 31, 2027, incorporated in the capitation rates through a separate payment term of up to $148.8 million for January 1, 2025 - December31, 2025; $148.8 million for the January 1, 2026 – December 31, 2026; and $148.8million for January 1, 2027 – December 31, 2027.

The Hospital Quality Incentive proposal for the rating period covering January 1, 2025through December 31, 2027, incorporated in the capitation rates through a separate payment term of up to $160.8 million for January 1, 2025 – December 31, 2025; $160.8million for January 1, 2026 – December 31, 2026; and $160.8 million for January 1, 2027–December 31, 2027.

The Performance Improvement Initiative for Professional Services proposal for the rating period covering January 1, 2025, through December 31, 2027, incorporated in the capitation rates through a separate payment term of up to $75 million for January 1, 2025–December 31, 2025; $75 million for January 1, 2026 – December 31, 2026; and $75million for January 1, 2027 – December 31, 2027.

Minimum Fee Schedule for behavioral health outpatient services including 24 hour diversionary substance use disorder services and behavioral health diversionary 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 $156,155,556.

The Hospital Performance Improvement Initiative proposal for the rating period covering January 1, 2025 through December 31, 2027, incorporated in the capitation rates through a separate payment term of up to $125 million for calendar year (CY) 2025, $125 million for CY 2026, and $125 million for CY 2027.

Uniform increase established by the State for Behavioral Health Urgent Care (BHUC) for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.