Approved State Directed Payment Preprints

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, 2024 through September 30, 2025, incorporated into the capitation rate through a separate payment term of up to $3.0931 billion.

Uniform percent increase for dental services for the rating period covering January 1, 2025, through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.

Uniform increase established by the state for eligible inpatient and outpatient hospital services for the rating period covering January 1, 2024 through December 31, 2024,incorporated into the capitation rates through a separate payment term of up to$411,000,000.

Population-based payment established by the state for Medicaid managed care enrollees attributed to eligible primary care providers who have active New York State Patient Centered Medical Home (PCMH) recognition and have attested to developing a referral workflow with regional Social Care Networks for the rating period, April 1, 2025 through March 31, 2026, incorporated into the capitation rates through a separate payment term up to $132,600,000.

Population-based payment established by the state for Medicaid managed care enrollees attributed to eligible primary care providers who have active New York State Patient Centered Medical Home (PCMH) recognition for the rating period, April 1, 2025 through March 31, 2026, incorporated into the capitation rates through a separate payment term up to $236,942,620.

A uniform dollar increase for psychotherapy services that utilize dialectical behavior therapy (DBT) for behavioral health outpatient services for the rating period covering July 1, 2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term of up to $3,268,000.

A uniform dollar increase for psychotherapy services that utilize dialectical behavior therapy (DBT) for behavioral health outpatient services 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 $172,000.

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, 2024 through September 30, 2025, and incorporated in the capitation rates through a separate payment term of up to $59,120,000.

Minimum and maximum fee schedules established by the state for the rating period, January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a risk-based rate adjustment.

Uniform increase for licensed mental health providers, and certain provisionally licensed mental health providers, who perform specific services for the rating period covering July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $18,400,000.