Nevada Medicaid managed care: what plans must pay

Managed-care plans don't publish their provider fee schedules. What is public is the rule each plan must follow, set in Nevada's plan contracts, statutes and notices. For 18 of 21 service lines, plans must follow a rule tied to the state's published rates.

Lines with a binding rule: 18of 21
Plans on record: 9
Directed payments: 36
Capitation cells: 360$0.42–$140,141.20 PMPM

Who sets the rate, by service line

Service line	Main rule for plans	Rates	Also applies
Physician & professional	Plans must pay at least thisPlans must pay at least the published rate	34,900	Paid by the state, outside plansPlans negotiate; applies out of network
Hospital outpatient	Plans must pay at least thisPlans must pay at least the published rate	22,097	Plans negotiate; applies out of network
Radiology	Plans must pay at least thisPlans must pay at least the published rate	7,340
Lab & pathology	Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network	5,229	Plans must pay at least thisPaid by the state, outside plans
Equipment & supplies	Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network	4,861	Plans must pay at least thisPaid by the state, outside plans
Pharmacy	Plans must pay at least thisPlans must pay at least the published rate	1,416	Paid by the state, outside plans
Dental	Plans must pay at least thisPlans must pay at least the published rate	1,068	Plans negotiate; applies out of networkPaid by the state, outside plans
Behavioral health	Plans must pay at least thisPlans must pay at least the published rate	777	Paid by the state, outside plansPlans negotiate; applies out of network
Vision & hearing	Plans must pay at least thisPlans must pay at least the published rate	412	Paid by the state, outside plansPlans negotiate; applies out of network
Therapy (PT/OT/speech)	Plans must pay at least thisPlans must pay at least the published rate	176	Paid by the state, outside plansPlans negotiate; applies out of network
Nursing facility	Paid by the state, outside plansPaid directly by the state, outside managed care	172
Other	State-directed paymentDirected payments add to plan rates	137	Plans must pay at least this
Hospital inpatient	Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network	122
IDD services	Paid by the state, outside plansPaid directly by the state, outside managed care	116	Plans must pay at least this
Other home & community services	Paid by the state, outside plansPaid directly by the state, outside managed care	57	Plans must pay at least thisPlans negotiate; applies out of network
ABA / autism services	Plans must pay at least thisPlans must pay at least the published rate	52	Paid by the state, outside plans
Transportation	Paid by the state, outside plansPaid directly by the state, outside managed care	34	Plans must pay at least this
Home health	Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network	20
Private duty nursing	Paid by the state, outside plansPaid directly by the state, outside managed care	20	Plans must pay at least thisPlans negotiate; applies out of network
Personal care & attendant	Paid by the state, outside plansPaid directly by the state, outside managed care	19	Plans negotiate; applies out of networkPlans must pay at least this
Clinics (FQHC/RHC)	Plans must pay at least thisPlans must pay at least the published rate	17

State-directed payments

Payments CMS approved under 42 CFR 438.6(c) that plans must make on top of, or as a minimum for, their negotiated rates.

Program	Amount	Effective
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	65.38%	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	43.65%	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	61.79%	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	59.62%	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	245%	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	877%	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	$2,274.71	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	$5,259.42	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	$1,100.00	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	$1,575.00	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	$800.00	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	$4,072.62	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	$921.26	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	$1,949.10	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	$521.37	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	$1,438.03	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	$699.54	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	$1,511.81	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	34.62%	2026-01-01
Nevada Medicaid managed care state directed payments (42 CFR 438.6(c))	65.38%	2026-01-01

Frequently asked questions

Do Nevada Medicaid plans have to pay the state fee schedule?

For some services. Plans must follow a rule tied to the state's rates for: Physician & professional, Hospital outpatient, Radiology, Lab & pathology, Equipment & supplies, Pharmacy, Dental, Behavioral health, Vision & hearing, Therapy (PT/OT/speech), Other, IDD services, Other home & community services, ABA / autism services, Transportation, Private duty nursing, Personal care & attendant, Clinics (FQHC/RHC). For other lines, plans negotiate rates with providers.

Where do these rules come from?

From Nevada's managed-care plan contracts, state statutes and regulations, provider notices and CMS-approved directed-payment filings. Each rate in the workspace carries its citation.

Can I see what each plan actually pays?

No plan publishes its provider fee schedule. The closest public signals are the binding rules above, state-set rates, directed payments and the state's own payment-level estimates in its directed-payment filings.

← All Nevada Medicaid rates

Nevada managed care, rate by rateSee the plan rule on every rate you bill, with the contract citation.

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