Approved State Directed Payment Preprints

Uniform percentage increase payment arrangement for professional services at an academic medical center for rating periods covering January 1, 2026, through December31, 2026, incorporated in the capitation rates through a separate payment term amount of up to $38,000,000.

Uniform percentage increase payment arrangement for professional services at an academic medical center for rating periods covering January 1, 2026, through December31, 2026, incorporated in the capitation rates through a separate payment term amount of up to $35,572,805.

Uniform percentage increase of 2.9% per claim for inpatient hospital services for rating period covering July 1, 2024, through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment of up to $93,384.

Uniform percentage increase of 2.9% for outpatient hospital services for the rating period covering July 1, 2024, through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment of up to $40,632.

Uniform increase established by the state for physicians providing professional services employed by or under contracts with South Carolina public medical university, academic medical center or its component units, or a South Carolina area Health Education Consortium (AHEC) Teaching Health System for the rating period covering July 1, 2025through July 30, 2026, incorporated in the capitation rates through a separate payment term of up to $160,028,404.

Uniform percentage increase University of Virginia, Virginia Commonwealth university and Eastern Virginia Medical Center 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 $274,100,000.

Value-based payment arrangement for Nursing Facilities for rating periods covering July1, 2025, through June 30, 2026, incorporated in the capitation rates through a separate payment term amount of up to $184,900,000.

Uniform percentage increase for inpatient hospital services and outpatient hospital services 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 $4,537,015,620.

 Uniform increase for inpatient and outpatient hospital services at freestanding children’s hospitals with more than 100 licensed pediatric beds for the rating period covering October 1, 2025 through September 30, 2026, and incorporated in the capitation rates through a separate payment term of up to $104,870,000.

Uniform percentage increase, entitled Access to Professional Services Initiative, established by the state for qualified practitioners affiliated with one of the designated 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 $388,330,000.