Approved State Directed Payment Preprints

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.

The Hospital Performance Improvement Initiative 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 $125 million for calendar year (CY) 2025, $125 million for CY 2026, and $125 million for CY 2027.

Uniform percentage increase established by the state for Differential Adjusted Payments (DAP) program eligible providers for the rating period covering October 1, 2025 through September 30, 2026, and incorporated in the capitation rate through a risk based adjustment.

Population-based payment established by the state for Mobile Response and Stabilization Services (MRSS) program providers for the rating period, January 1, 2026through December 31, 2026, incorporated into the capitation rates through a separate payment term up to $48,885,706.

Uniform percentage increase for professional services at an academic medical center for state teaching hospitals 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$49,595,750.