Approved State Directed Payment Preprints

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.

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$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.