Approved State Directed Payment Preprints

Minimum Fee Schedule established by the state for eligible non-state government owned skilled nursing facilities for actual utilization of services for rating periods covering July1, 2025 – June 30, 2026, incorporated in the capitation rates through a risk-based rate adjustment.

Minimum fee schedule established by the state for local health department services for rating periods covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term amount of up to $82,900,000.

Uniform dollar increase for children’s inpatient and outpatient services with recognized children’s hospitals established by the state for rating periods covering July 1, 2025through June 30, 2026, incorporated in the capitation rates through a separate payment term amount of up to $1,309,591.

A uniform increase for primary care services for the rating period covering July 1, 2024through December 31, 2024, incorporated in the capitation rates through a separate payment term amount of up to $7 million.

Renewal of the uniform percentage increase established by the state for qualified practitioners who are members of a practice plan under contract to provide professional services at a state-owned academic medical center for the rating period covering January1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $34 million.

Value based payments for dental providers for the rating period covering January 1,2025 through December 31, 2025, incorporated in the capitation rates through a risk-based adjustment.

Value based payments for dental providers for the rating period covering January 1,2025 through December 31, 2025, incorporated in the capitation rates through a risk-based adjustment.

Uniform dollar increase for dental services for the rating period covering January 1,2025 through December 31, 2025, incorporated in the capitation rates through a risk-based adjustment.

Uniformed percentage increase for physicians employed by or contracted with a private acute care type 2 hospital system with at least on 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, 2025 through June 30, 2026, incorporated into the capitation rates through a separate payment term up to $8,567,924.00.

Uniform percentage increase for physician services by physicians employed by or contracted with an acute care hospital chain with a level one trauma center in the Tidewater Metropolitan Statistical Area (MSA) in 2020, for rating period July 1, 2025through June 30, 2026, incorporated in the capitation rates through a separate payment term amount of up to $21,048,306.