Approved State Directed Payment Preprints

Value based payment arrangement for Children’s Integrated Services (CIS) providers established by the state for the rating period January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.

Value based payment arrangement for Children’s Integrated Services (CIS) providers established by the state for the rating period January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.

The enhanced minimum fee schedule for home and community-based services approved through the state’s 1115 waiver for the rating period, April 1, 2024 through March 31, 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 type 2 hospital system with at least one level 2 trauma center as of January 2022 located in Lord Fairfax Health District and Northwest Health Planning Region, for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $3,599,290.

Long-term care delivery system reform, transitioning coverage from fee-for-service to managed care at fee-for-service per-diem rates, for the rating periods covering January 1,2023 through December 31, 2025, incorporated into the capitation rates through a risk-based rate adjustment.

A uniform dollar increase established by the state for eligible government-owned emergency medical transport providers for the rating period covering January 1, 2025through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $16.83 million.

Uniform increase for physician services provided by physicians who participate in Children’s Specialty Group, affiliated with Children’s Hospital of the King’s Daughters, for the rating period, July 1, 2025 through June 30, 2026, incorporated into the capitation rates through a separate payment term up to $11,050,000.

Uniform percentage increase for physician services by physicians employed by or contracted with a private acute care type 2 hospital system with at least one level 2 trauma center as of January 2022 with at least 290 beds in cost report period 2020 located in the Eastern Health Planning Region, for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $8,567,924.

Uniform increase by the state for primary care, behavioral health outpatient, and justice involved clinic services for the rating period October 1, 2023 through September 30, 2024, incorporated into the capitation rates through a separate payment term up to $59 million.

Value based payment arrangement established by the state for eligible primary care and behavioral health providers contracted with the Egyptian Health Department for the rating periods covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.