Approved State Directed Payment Preprints

Minimum fee schedule established by the State for outpatient behavioral health services and behavioral health diversionary services for the rating period covering January 1, 2023 through December 31, 2023, provided by the MA Behavioral Health Partnership, Senior Care Options (SCO), or One Care plans, and incorporated in the capitation rates through a risk-based rate adjustment.

The minimum fee schedule for Acute Treatment Services (ATS) and Clinical Support Services (CSS) (which may include individualized treatment services in a specialized setting), and Residential Rehabilitation Services (RRS) services established by the state for the rating period covering January 1, 2023 through December 31, 2023, incorporated into the capitation rates through a risk-based adjustment.

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 through September 30, 2025, incorporated in the capitation rates through a risk-based rate adjustment.

Minimum fee schedule established by the state for eligible specialty physician services that are covered at 100% of Medicare and eligible behavioral health outpatient services that are covered at 80% of Medicare consistent with the requirements of the
Consolidated Appropriations Act of 2023 for the rating period covering October 1, 2023 through September 30, 2024 incorporated in the capitation rates through a risk-based adjustment.
 

Uniform dollar increase established by the state for emergency ground ambulance providers 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$62,463,235.

Population-based payment established by the state for Medicaid managed care enrollees attributed to eligible primary care providers who have active New York State Patient Centered Medical Home (PCMH) recognition for the rating period, April 1, 2024 through March 31, 2025, incorporated into the capitation rates through a separate payment term up to $132,600,000.
 

Renewal of the uniform dollar increase for inpatient and outpatient hospital services and performance-based quality payments established by the state for the State Teaching Hospital that provides guaranteed access to care for Native Americans for the rating period covering July 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $155 million.

The Uniform Increase for eligible Acute Care Hospitals established by the state for Inpatient, Outpatient, and Physician Services for the rating period covering July 1, 2023through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $343,997,344.

Uniform percentage increase for outpatient hospital services, primary care services, specialty physician services, behavioral health outpatient services, dental services, and providers providing EPSDT services, established by the state for the rating period covering July 1, 2023, through June 30, 2024, incorporated in the capitation rates through a rate adjustment of up to $5,700,000.

Uniform dollar increase for community mental health programs for the rating period covering September 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term of up to $4,166,666.67.