Approved State Directed Payment Preprints

Uniform dollar increase established by the state for inpatient hospital services, primary care services, and specialty physician services for the rating period covering July 1, 2025through June 30, 2026, incorporated into the capitation rates through a separate payment term amount of up to $6,603,083.

Quality Payment/Pay for Performance (Category 2 APM, or similar) for inpatient and outpatient hospital services for the rating period covering July 1, 2025 through June 30,2026, incorporated into the capitation rates through a separate payment term in the amount of $233,573,938.

Value Based Payment to meet or exceed the performance measure benchmarks on specific provider quality metrics for outpatient hospital services to receive incentive payments for the rating period covering January 1, 2026 through December 31, 2027 for a multi-year period, incorporated in the capitation rates through a separate payment term of up to $60,000,000.

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, 2026 through December 31, 2026, incorporated into the capitation rates through a separate payment term up to $480,400,000.

The amendment of the uniform percentage increase and performance improvement initiatives payments established by the state for eligible inpatient and outpatient hospital 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 $1,540,423,694.

The Uniform Increase for eligible Acute Care Hospitals established by the state for Specialty Physician Services for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term up to$47,949,316.

Uniform percentage increase for inpatient and outpatient hospital services, and a value-based performance payment to providers who attain quality performance target(s), starting July 1, 2025 for the rating period covering January 1, 2025 through December 31, 2025, incorporated into capitation rates via a separate payment term up to $85,774,951.

Uniform Dollar Increase for inpatient hospital services for the rating period covering October 1, 2025 through September 30, 2026, incorporated in the capitation rates through a separate payment term amount up to $123,350,308.

Value based payment arrangement established by the state for eligible primary care and behavioral health providers contracted with the Egyptian Health Department for the rating periods covering January 1, 2026 through December 31, 2027, incorporated in the capitation rates through a risk-based rate adjustment up to $449,820 per year.

Uniform percentage increase for nursing facility services 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 $39,062,500.