Approved State Directed Payment Preprints

A perinatal episode of care pilot established by the state for the rating period covering July 1, 2025, through June 30, 2026, incorporated into the capitation rates through a risk-based rate adjustment and separate payment terms of up to $3,500,000.

Uniform dollar increase for nursing facilities based on quality weighted Medicaid days for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $57.5 million.

Uniform dollar increase for eligible inpatient hospital and outpatient hospital services at Government general hospitals, other than those operated by the State of New York or the State University of New York, located in a city with a population of over one million for the rating period covering April 1, 2024, through March 31, 2025, incorporated in the capitation rates through a separate payment term of up to $2,287,256,013.

Uniform percentage increase and performance improvement initiative payments established by the state for inpatient hospital services, outpatient hospital services, and rural emergency hospital services for the rating period, July 1, 2025 through June 30,2026, incorporated into the capitation rates through a separate payment term of up to $1,510,325,958.

Uniform dollar increase and minimum fee schedule for home and community-based services and behavioral health outpatient services established by the state for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a risk-based rate adjustment.

Uniform increase for inpatient and outpatient services delivered by qualifying financially distressed hospitals for the rating period, April 1, 2025 through March 31, 2026, incorporated into the capitation rates through a separate payment term up to $1,840,386,150.

Uniform increase established by the state for inpatient and outpatient services at eligible Illinois hospitals 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 $8,000,000,000.

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 $600,000,000.

The uniform dollar increase for inpatient discharges and outpatient visits to qualifying critical access hospitals for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term amount of up to $94,725,164.

Uniform increase for Sole Community Hospitals as established by the state for outpatient services for the rating period, April 1, 2025 through March 31, 2026, incorporated into the capitation rates through a separate payment term up to $145,653,499.