Approved State Directed Payment Preprints

Integrated Care Incentive proposal for non-state, public hospitals for the rating periods covering January 2, 2025 to December 31, 2027, incorporated in the capitation rates through a separate payment term of up to $148.8 million for January 1, 2025 - December31, 2025; $148.8 million for the January 1, 2026 – December 31, 2026; and $148.8million for January 1, 2027 – December 31, 2027.

Minimum Fee Schedule established by the state for eligible non-state government owned nursing facilities for actual utilization of services 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 $5,650,000.

The Hospital Quality Incentive proposal for the rating period covering January 1, 2025through December 31, 2027, incorporated in the capitation rates through a separate payment term of up to $160.8 million for January 1, 2025 – December 31, 2025; $160.8million for January 1, 2026 – December 31, 2026; and $160.8 million for January 1, 2027–December 31, 2027.

The Performance Improvement Initiative for Professional Services proposal for the rating period covering January 1, 2025, through December 31, 2027, incorporated in the capitation rates through a separate payment term of up to $75 million for January 1, 2025–December 31, 2025; $75 million for January 1, 2026 – December 31, 2026; and $75million for January 1, 2027 – December 31, 2027.

Texas Incentive Physicians and Professional Services, which has components consisting of both uniform increases and pay for performance for eligible providers, for the rating period covering September 1, 2025 through August 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment of up to $645,410,146.

Uniform percentage increase for inpatient and outpatient hospital services provided at qualifying non-state owned or operated hospitals 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 $1,478,197,798.

Amendment to a value-based purchasing and uniform percent increase arrangement established by the state to increase nursing facility per diem rates by the market basket index (MBI) factor and to provide quality incentive payments for nursing facilities that meet performance requirements on specified quality metrics for the rating period covering January 1, 2023 through December 31, 2023, incorporated into the capitation rates through a risk-based adjustment.

Value-based payment arrangement for the Vermont Medicaid Next Generation (VMNG) ACO program for the rating period covering January 1, 2025 through December 31,2025, incorporated into the capitation rates through a risk-based adjustment.

Minimum Fee Schedule for behavioral health outpatient services including 24 hour diversionary substance use disorder services and behavioral health diversionary services for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment of up to $156,155,556.

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, 2026, through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment up to $100,000.