Approved State Directed Payment Preprints

Uniform percentage increase for inpatient hospital and outpatient hospital services for rating periods covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term amount up to $363,586,833.

Uniform dollar increase established by the state for inpatient hospital services, outpatient hospital services, and professional services at an academic medical center for the rating period, January 1, 2026 through December 31, 2026, incorporated into the capitation rates through a risk-based rate adjustment up to $1,887,207,120; and Value-based payment established by the state for inpatient hospital services, outpatient hospital services, and professional services at an academic medical center for the rating period, January 1, 2026 through December 31, 2026, incorporated into the capitation rates through a separate payment term up to $471,801,780.

Uniform increase and value-based payment established by the state for inpatient hospital services and outpatient hospital services for the rating period covering January 1, 2026through December 31, 2026, incorporated into the capitation rates through a separate payment term amount of up to $2,839,461,363.

Uniform dollar increase for eligible ground emergency ambulance services for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment up to $11,679,734.18.

Minimum Fee Schedule for facilities authorized by Casgevy and Lyfgenia manufacturers to administer the therapies for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a risk-based rate adjustment up to $0, reflecting that Managed Care Organizations (MCOs) are already reimbursing according to this methodology based on limited available data, and therefore no additional financial impact is expected from implementing this payment arrangement.

Renewal of the uniform percentage increase established by the state for inpatient 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, 2026 through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment up to $9.94 million.

Uniform percentage increase for qualified practitioner services at an academic medical center and a value-based performance payment to providers who attain quality performance target(s), starting July 1, 2025 for the rating period covering January 1, 2025through December 31, 2025, incorporated into capitation rates through a separate payment term of up to $52,748,499.

Uniform percentage increase for qualified practitioner services at an academic medical center and a value-based performance payment to providers who attain quality performance target(s), starting July 1, 2025 for the rating period covering January 1, 2025through December 31, 2025, incorporated into capitation rates through a separate payment term of up to $125,000,000.

Uniform percentage increase for qualified practitioner services at an academic medical center and a value-based performance payment to providers who attain quality performance target(s), starting July 1, 2025 for the rating period covering January 1, 2025through December 31, 2025, incorporated into capitation rates through a separate payment term of up to $3,927,403.

Uniform percentage increase for qualified practitioner services at an academic medical center and a value-based performance payment to providers who attain quality performance target(s), starting July 1, 2025 for the rating period covering January 1, 2025through December 31, 2025, incorporated into capitation rates through a separate payment term of up to $4,963,884.