Approved State Directed Payment Preprints

Renewal of a uniform increase for primary care services for the rating period covering January 1, 2026 through December 31, 2026, incorporated into the capitation rates through a separate payment term of up to $26 million.

Primary Care Sub Capitated Arrangement established by the state for the rating period, January 1, 2025 through December 31, 2027, incorporated into the capitation rates through a risk-based adjustment.

The uniform dollar increase for primary care services to meet Healthy Steps model fidelity for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a risk-based rate adjustment of up to $98,385.

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 of up to $374.7 Million.

Uniform percentage increase for inpatient and outpatient hospital services provided at qualifying Iowa state-owned or operated teaching hospitals as defined in the Medicaid State Plan 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$704,664,323.

Quality Payment/Pay for Performance (Category 2 APM, or similar) for Certified Community Behavior Health Center’s (CCBHC) services for rating periods covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term amount of up to $3,695,094.83.

Uniform increases established by the state for inpatient and outpatient services provided by all in-state hospitals for the rating period covering January 1, 2025 through December31, 2025, incorporated into the capitation rates through a separate payment term up to$3.9 billion.

Uniform percentage increase for physician and professional services provided at qualifying Iowa state-owned or operated professional services practices as defined in the Medicaid State Plan for rating periods covering July 1, 2025 through June 30, 2026,incorporated in the capitation rates through a separate payment term amount of up to$136,779,796.

Uniform percentage increase for dental services for the rating period covering January 1,2026 through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment of up to $63,373,184.

Minimum Fee Schedule for Integrated Community Wellness Centers for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment of up to $49,874,341.00.