Approved State Directed Payment Preprints

Minimum fee schedules established by the state for the following provider classes and services for the rating period, January 1, 2026 through December 31, 2026, incorporated into the capitation rates through a risk-based rate adjustment with a zero dollar impact:
•Nursing facilities, HCBS providers for individuals who are elderly and/or have physical disabilities, HCBS providers for individuals with intellectual and developmental disabilities, Providers of behavioral health crisis prevention, intervention, and stabilization services for individuals with intellectual disabilities, Behavioral health mobile crisis centers
Maximum fee schedules established by the state for the following provider classes and services for the rating period, January 1, 2026 through December 31, 2026, incorporated into the capitation rates through a risk-based rate adjustment with a zero dollar impact:
•Durable medical equipment for back braces, Physical therapists, occupational therapists, and speech therapists for specified codes, C-section deliveries.

Uniform Percentage Increase for inpatient and outpatient hospital services for the rating period covering, January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term up to $3,204,114,577.

Uniform percentage increase established by the state for eligible home and community-based services 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$115,000,000.

Uniform percentage increase established by the state for eligible home and community-based services 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$91,000,000.

Uniform percentage increase established by the state for eligible home and community-based 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 $147,000,000.

Minimum Fee Schedule for home and community-based services 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 $231,000,000.

Uniform increase established by the state for primary care and specialty physician services provided by practitioners employed or under contract with approved public entities, for the rating period covering October 1, 2025 through September 30, 2026, incorporated in the capitation rates through a separate payment term up to$610,000,000.

Uniform percentage increase established by the state for Differential Adjusted Payments (DAP) program eligible providers for the rating period covering October 1, 2025 through September 30, 2026, and incorporated in the capitation rates through a risk based adjustment up to $150,850,000.

Uniform increase established by the state for inpatient services at hospitals participating in delivery system transformation programs approved 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 up to $190,000,000.

Minimum fee schedule for behavioral health outpatient services furnished by qualified providers for the rating period covering January 1, 2026 through December 31, 2026,incorporated into the capitation rates through a risk-based adjustment.