Approved State Directed Payment Preprints

Value-based purchasing established by the state for eligible nursing facility services for the rating period, January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term up to $15,000,000.

Uniform increase established by the state for physicians providing professional services employed by or under contracts with South Carolina public medical university, academic medical center or its component units, or a South Carolina area Health Education Consortium (AHEC) Teaching Health System for the rating period covering July 1, 2025through July 30, 2026, incorporated in the capitation rates through a separate payment term of up to $160,028,404.

Value based pay for performance and population-based payment for behavioral health outpatient services provided by eligible mobile crisis response providers established 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 amount of up to $4,307,393.

Uniform percentage increase University of Virginia, Virginia Commonwealth university and Eastern Virginia Medical Center for professional services at an academic medical center 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 $274,100,000.

Uniform percentage increase established by the State for eligible home and community-based service (HCBS) services for rating periods covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term amount of up to $147,000,000.

Uniform percentage increase for inpatient hospital services and outpatient hospital services for rating periods covering July 1, 2024, through June 30, 2025, incorporated in the capitation rates through a separate payment term amount of up to $4,537,015,620.

Value-based payment arrangement for the Patient-Centered Medical Home (PCMH) PPPM (Per Patient Per Month) Blueprint payment program for the rating periods covering January 1, 2025 through December 31, 2027, incorporated into the capitation rates through a risk-based rate adjustment.

Uniform dollar increase for eligible ground emergency ambulance services for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment of up to $10,904,534.33.

Uniform percentage increase of 2.9% for outpatient hospital services for the rating period covering July 1, 2024, through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment of up to $40,632.

Value-based payment arrangement for Nursing Facilities for rating periods covering July1, 2025, through June 30, 2026, incorporated in the capitation rates through a separate payment term amount of up to $184,900,000.