Approved State Directed Payment Preprints

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, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.

Value-based payment and uniform dollar increase established by the state for primary care services for the rating period, January 1, 2025 through December 31, 2025,incorporated into the capitation rates through a risk-based rate adjustment.

Minimum Fee Schedule for Community Mental Health Centers and Comprehensive Behavioral Health Providers for the rating period covering July 1, 2024 through June 30,2025, incorporated in the capitation rates through a risk-based rate adjustment.

 Uniform increase established by the state for home and community-based services providers, behavioral health providers, and school-based services providers for the rating period covering July 1, 2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term of up to $12,506,781.

Quality incentive program for inpatient hospital services, outpatient hospital services, primary care services, and specialty physician services at Nemours Children’s Hospital for the rating period covering January 1, 2025 through December 31, 2027, incorporated in the capitation rates through a risk-based rate adjustment.

Uniform increase for professional services at an academic medical center provided by Qualified Licensed Professionals as established by the state for the rating period, January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term up to $16,000,000.

The uniform dollar increase established by the state for direct care workers providing personal care services to eligible enrollees for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.

Uniform dollar increase for children’s inpatient and outpatient services with recognized children’s hospitals established by the state for rating periods covering September 1,2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term amount of up to $1,229,000.

A uniform dollar increase established by the state for eligible public and government-owned emergency medical transport providers for the rating period covering July 1, 2024through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $5.08 million.

Uniform increase established by the state for emergency medical transport services provided by public and government-owned or operated ambulance service providers 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 $13,062,198.