Approved State Directed Payment Preprints

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.

Quality Improvement Payment Program (QIPP) for the rating period covering September1, 2024 through August 31, 2027, incorporated in the capitation rates through a risk-based rate adjustment.

The uniform dollar increases established by the state for inpatient hospital services provided by eligible Critical Access Hospitals and Prospective Payment System Hospitals and the uniform percentage increases established by the state for outpatient hospital services provided by eligible Critical Access Hospitals and Prospective Payment System Hospitals for the rating period January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term up to $2.003 billion.

Uniform percentage increase for inpatient and outpatient services with designated public hospitals operated by a public hospital district established by the state, excluding critical access hospitals, for the rating period, January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term up to $255.2 million.

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, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term up to $480,400,000.

Uniform increase for critical access hospitals established by the state for outpatient hospital services for the rating period, January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term up to $13,500,000.

Uniform dollar increase for nursing facilities based on quality weighted Medicaid days 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 $70 million.

Pay for performance arrangement established by the state for public and private nursing facilities 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 $2.8 million; and, Uniform dollar increase established by the state for nursing facility services within government-owned nursing facilities 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 $17.86 million.
 

The Uniform increase for professional services furnished by physician practice plans affiliated with a medical school located in Philadelphia and accredited by the Liaison Committee on Medical Education for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through separate payment term of up to $35,572,805.

 Uniform percentage increase for eligible professional services at designated academic medical centers 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 $59,883,102.81.