Approved State Directed Payment Preprints

Uniform increase established by the state for emergency medical transport services provided by ground non-governmental ambulance services 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 $16,226,538.

Uniform increase established by the state for dispensing fees for Independent Community Pharmacies for the rating period covering July 1, 2025 through June 30,2026, incorporated in the capitation rates through a separate payment term of up to$9,500,000.

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, 2025 through December 31, 2025 incorporated in the capitation rates through a separate payment term of up to $103.5 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, 2025 through December 31, 2025 incorporated in the capitation rates through a separate payment term of up to $78.47 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, 2025 to December 31, 2025 incorporated in the capitation rates through a separate payment term of up to $241.69 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, 2025 to December 31, 2025 incorporated in the capitation rates through a risk-based adjustment.
 

Uniform increase established by the state for inpatient and outpatient services at hospitals participating in delivery system transformation programs approved by the state 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 $190,000,000.

Uniform increase established by the state for inpatient labor and delivery services at Safety Net hospitals 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 $50,000,000.

Quality Improvement Payment Program (QIPP) for the rating period covering September1, 2024 through August 31, 2027, incorporated in the capitation rates through a risk-based rate adjustment.

Uniform percentage increase for inpatient and outpatient services with designated public hospitals operated by a public hospital district established by the state, excluding critical access hospitals, for the rating period, January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term up to $255.2 million.

The uniform dollar increases established by the state for inpatient hospital services provided by eligible Critical Access Hospitals and Prospective Payment System Hospitals and the uniform percentage increases established by the state for outpatient hospital services provided by eligible Critical Access Hospitals and Prospective Payment System Hospitals for the rating period January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term up to $2.003 billion.

Uniform percentage increase for hospitals owned and operated by or operated by a state university established by the state 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 $480,400,000.

Uniform dollar increase for nursing facilities based on quality weighted Medicaid days 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 $70 million.