Approved State Directed Payment Preprints

Maximum fee schedule for inpatient and outpatient hospital services established by the state for the rating period covering July 1, 2024, through June 30, 2025, incorporated in the capitation rates through a risk-based rate adjustment.

Minimum Fee Schedule established by the state for durable medical equipment for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a risk-based rate adjustment.

Renewal of 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, 2025 through June 30, 2025, incorporated into the capitation rates through a risk-based adjustment.

Renewal of the value-based payment and uniform increase established by the state for participating nursing facilities that demonstrate quality improvement for the rating period covering January 1, 2025 through June 30, 2025, incorporated in the capitation rates through a risk-based rate adjustment.

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 January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $310 million.

Uniform increase and value-based payment arrangement established by the state to implement the Healthcare Delivery Access Act, for inpatient and outpatient hospital services for the rating period January 1, 2025 through December 31, 2025, incorporated
into the capitation rates through a separate payment term up to $1.5 billion.
 

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, 2024through June 30, 2025, incorporated in the capitation rates through a separate payment term of up to $1,336,557,110.

Population-based payment established by the state for primary care services for the rating period, October 1, 2024 through September 30, 2025, incorporated into the capitation rates through a risk-based rate adjustment.

Uniform percentage increase for physician services by physicians employed by or contracted with a private acute care hospital system with a level one trauma center located in the Tidewater Metropolitan Statistical Area (MSA) in 2020, for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $21,048,306.

The value-based payment arrangement for community-based residential substance use treatment facilities for the rating period covering January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a risk-based rate adjustment.