Approved State Directed Payment Preprints

• Pay for performance arrangement established by the state for public and private nursing facilities as defined in the preprint for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $2.71 million; and,
• Uniform dollar increase established by the state for nursing facility services within government-owned nursing facilities for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $32.96 million.

• Pay for performance arrangement established by the state for public and private hospitals as defined in the preprint for the rating period covering January 1, 2024 through December 31, 2024 incorporated in the capitation rates through separate payment term of up to $46.15 million; 
• Uniform dollar increase established by the state for safety net hospitals owned and operated by a government agency for the rating period covering January 1, 2024 through December 31, 2024 incorporated in the capitation rates through a separate payment term of up to $86.46 million; 
• Uniform percentage increase established by the state for inpatient and outpatient hospital services within privately-owned hospital provider classes for the rating period covering January 1, 2024 to December 31, 2024 incorporated in the capitation rates through a separate payment term of up to $162.2 million; and, 
• Minimum and Maximum fee schedule established by the state for in-state general acute hospitals and children’s hospital services within in-state general acute hospital provider classes for the rating period of January 1, 2024 to December 31, 2024 incorporated in the capitation rates through a risk-based adjustment.

Rural Access to Primary and Preventative Services (RAPPS) for the rating period covering September 1, 2023 through August 31, 2024, incorporated in the capitation rates through a risk-based rate adjustment.

• Uniform increase established by the state for inpatient and outpatient hospital services and professional services at an academic medical center for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based adjustment; and, 
• Value-based payment established by the state for inpatient and outpatient hospital services and professional services at an academic medical center 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 $380,395,158.

Amendment: the uniform increase for inpatient and outpatient hospital services and performance-based quality payments established by the state for hospitals that provide guaranteed access to care for Native Americans through the Indian Health Service for the rating period covering January 1, 2023 through December 31, 2023, incorporated into the capitation rates through a separate payment term of up to $193 million.

Renewal of the uniform percentage increase established by the state for inpatient and outpatient services by for-profit/investor owned and government-owned hospitals for the rating period covering January 1, 2024 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.

Renewal of the uniform percentage increase established by the state for inpatient and outpatient services by not-for-profit hospitals for the rating period covering January 1, 2024 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.

Renewal of the uniform increase arrangement for trauma hospitals established by the state for inpatient and outpatient services for the rating period covering January 1, 2024through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.

Renewal of the uniform percentage increase established by the state for inpatient and outpatient services provided by practice plans under contract to community hospitals that serve a disproportionate share of Native American enrollees for the rating period covering January 1, 2024 through June 30, 2024, incorporated in the capitation rates through a risk-based rate 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, 2024 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.