Approved State Directed Payment Preprints

The uniform percentage increase for nursing facility services provided by Class II (publicly owned) nursing facilities with greater than 500 licensed beds for the rating period for July 1, 2026 through June 30, 2027, incorporated in the capitation rates through a separate payment term amount up to $18,207,438.

Quality Payment/Pay for Performance (Category 2 APM, or similar) and Performance Improvement Initiative amendment for nursing facility services for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term amount up to $15,000,000.

Uniform percentage increase for professional services at an academic medical center, primary services, and specialty care services, for the rating period covering July 1, 2025 through June 30, 2026, incorporated into the capitation rates through a separate payment term up to $1,181,727,644.

The uniform dollar increase for primary care services to meet HealthySteps model fidelity for the rating period covering July 1, 2026 through June 30, 2027, incorporated in the capitation rates through a risk-based rate adjustment up to $223,500.

Uniform increase established by the state for qualified licensed professionals employed by a state university owned or operated hospital or affiliated practice, state owned and operated school of dentistry, or public hospital district for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term up to $132,480,000.

The uniform dollar increases established by the state for inpatient hospital services provided by eligible Critical Access Hospitals and Prospective Payment System Hospitals and the uniform percentage increases established by the state for outpatient hospital services provided by eligible Critical Access Hospitals and Prospective Payment System Hospitals for the rating period January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term up to $2.003 billion.

Amendment to a uniform dollar increase established by the state 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 up to $35,407,000.

Uniform percentage increase for inpatient hospital and outpatient hospital services rendered by all non-state government owned hospitals (CRMC and Lake Taylor Transitional Care Hospital) for the rating period covering July 1, 2026 through June 30, 2027, incorporated in the capitation rates through a separate payment term amount up to $74,610,061.

Uniform percentage increase for physicians employed by or contracted with the non-state government owned general acute care hospital class services for rating periods covering July 1, 2026 through June 30, 2027, incorporated in the capitation rates through a separate payment term amount up to $950,000.

Uniform percentage increase for professional services at an academic medical center for the rating period covering July 1, 2026 through June 30, 2027, incorporated in the capitation rates through a separate payment term amount up to $274,100,000.