Approved State Directed Payment Preprints

Uniform percentage increase for professional services at an academic medical center for the rating period covering February 1, 2025 through September 30, 2025, incorporated in the capitation rates through a separate payment term amount of up to $260,925,815.

Uniform increase for non-state owned or operated hospitals established by the state for inpatient and outpatient hospital services for the rating period, January 1, 2026 through December 31, 2026, incorporated into the capitation rates through a separate payment term up to $1,410,710,373.

The Total Cost of Care payment arrangement for the state’s Accountable Entities, as authorized in the state’s section 1115 demonstration for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a risk-based rate adjustment of up to $109,000,000.

Uniform increase established by the state for publicly funded sexual and reproductive health family planning providers as designated by the Department of Health for the rating period covering January 1, 2026, through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment up to $2,100,000.

Uniform increase for outpatient hospital services provided by Border City Children’s Hospitals and Large Public Teaching Hospitals for the rating period covering January 1,2026, through December 31, 2026, incorporated in the capitation rates through a separate payment term of up to $10,000,000.

Minimum Fee Schedule established by the state for durable medical equipment for the rating period covering July 1, 2026 through June 30, 2027, incorporated in the capitation rates through a risk-based rate adjustment of up to $17,968,705.

Maximum Fee Schedule for eligible non-contract providers for the rating period covering July 1, 2024 through December 31, 2024, incorporated in the capitation rates through a risk-based rate adjustment.

Uniform percentage increase for professional services at an academic medical center for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term amount up to $91,098,330.

Uniform dollar increase for inpatient and outpatient hospital services established by the state for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term amount up to $2,269,269,993.

Uniform increase established by the state for inpatient and outpatient hospital services that are eligible for the Hospital Rate Add-On for the rating period covering January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term up to $1,024,000,000.