Approved State Directed Payment Preprints

The Total Cost of Care payment arrangement for the state’s Accountable Entities, as authorized in the state’s section 1115 demonstration for the rating period covering July 1,2024 through June 30, 2025, incorporated in the capitation rates through a risk-based rate adjustment.

Uniform increase established by the state for publicly funded sexual and reproductive health family planning providers as designated by the Department of Health for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.

Uniform increase established by the state for behavioral health inpatient and outpatient services delivered by eligible providers for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a through a risk-based adjustment.

Uniform increase established by the state for eligible home and community based and behavioral health outpatient providers for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $27,000,000.

Uniform increase and value-based payment established by the state for inpatient and outpatient hospital services 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 $2,412,721,014.

Minimum Fee Schedule established by the State for the Program of Assertive Community Treatment (PACT) for the rating period covering January 1, 2023 through December 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.

Uniform percentage increase and performance improvement initiative payments established by the state for eligible inpatient and 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 critical access hospitals established by the state for outpatient hospital services for the rating period, January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $13,500,000.

Uniform percentage increase for inpatient and outpatient hospital services provided by eligible general hospitals, 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 $41,000,000.

The uniform dollar increase established by the state for direct care workers providing personal care services to eligible enrollees for the rating period covering October 1, 2024 until September 30, 2025 incorporated in the capitation rates through a risk-based rate adjustment.