Approved State Directed Payment Preprints

Minimum fee schedule for primary care services and specialty physician services for rating period covering February 1, 2025 through September 30, 2025, incorporated in the capitation rates through a risk-based rate adjustment amount of up to $150,707,779.

Uniform increase established by the state for acute inpatient and ambulatory outpatient services provided by Hospital Enhanced Access Leading to Health Improvements Initiative (HEALTH) program eligible hospitals 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 $4,105.7 million.

Uniform increase for faculty or staff members of an academic medical institution of a public university established by the state for the rating period, January 1, 2025through December 31, 2025, incorporated into the capitation rates through a risk-based rate adjustment of up to $25,135,163.

Uniform percentage increase for eligible professional services at an academic medical center for rating periods covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term amount of up to$56,071,432.20.

Uniform percentage increase established by the state for inpatient and outpatient hospital services for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term of up to $2,575,731,483.

Uniform dollar amount for eligible providers that provide private duty nursing services to members under age 21 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 $1,712,374.

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 of up to $1,750,000,000 for each rating period.

Uniform increase established by the state for inpatient and outpatient hospital services for the twenty smallest rural hospitals, for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term amount up to $55.83 million.

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.