The Centers for Medicare & Medicaid Services (CMS) Medicaid managed care regulations at 42 C.F.R. § 438 govern how states may direct plan expenditures in connection with implementing delivery system and provider payment initiatives under Medicaid managed care contracts. CMS began reviews of state directed payment arrangements beginning with contract rating periods on or after July 1, 2017. For more information on state directed payments, please visit our Guidance Page. Persons with disabilities having problems accessing the Preprint PDF files may call 410-786-0429 for assistance.
Approved State Directed Payment Preprints
Results
Displaying 1 - 10 of 231
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SDP Identifier:: NY_VBP_HCBS6_New_20230401-20240331
State: New York
Summary:
The value-based performance improvement initiative for qualifying Social Adult Day Care (SADC) sites established by the state for social adult daycare services for the rating period covering April 1, 2023 through March 31, 2024, incorporated in the capitation rates through a separate payment term of up to $14 million.
Approval Date:
Effective Date:
Links:
State Rating Period:
Payment Type:
Value-based payment
Provider Class:
HCBS/personal care services
Review Type: New
Approval Period: Single Rating Period
SDP Identifier:: NY_Fee_IPH1_Renewal_202300401-20240331
State: New York
Summary:
The uniform increase for qualifying hospitals established by the state for inpatient services for the rating period covering April 1, 2023 through March 31, 2024, incorporated into the capitation rates through a separate payment term of up to $650 million.
Approval Date:
Effective Date:
Links:
State Rating Period:
Payment Type:
Fee schedule
Provider Class:
Inpatient hospital service
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: IA_Fee_IPH.OPH1_New_20230701-20240630
State: Iowa
Summary:
Uniform increase for all non-state owned or operated hospitals eligible to receive inpatient and/or outpatient payments consistent with the Medicaid State Plan for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $1,300,000,000.
Approval Date:
Effective Date:
Links:
State Rating Period:
Payment Type:
Fee schedule
Provider Class:
Inpatient hospital service, Outpatient hospital service
Review Type: New
Approval Period: Single Rating Period
SDP Identifier:: IA_Fee_Oth_Renewal_20230701-20240630
State: Iowa
Summary:
Uniform increase established by the state for eligible ground emergency medical transportation providers for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
Effective Date:
Links:
State Rating Period:
Payment Type:
Fee schedule
Provider Class:
Other
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: VA_Fee_Oth_Renewal_20231001-20240630
State: Virginia
Summary:
The minimum fee schedule established by the state for Durable Medical Equipment providers for the rating period covering October 1, 2023 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
Effective Date:
Links:
State Rating Period:
Payment Type:
Fee schedule
Provider Class:
Other
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: MO_Fee_IPH_Renewal_20230701-20240630
State: Missouri
Summary:
Minimum and maximum fee schedules established by the state for inpatient hospital services for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
Effective Date:
Links:
State Rating Period:
Payment Type:
Fee schedule
Provider Class:
Inpatient hospital service
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: VA_Fee_IPH.OPH_Amend_20220701-20230630
State: Virginia
Summary:
Uniform increase for inpatient and outpatient services at private acute care hospitals for the rating period covering July 1, 2022 through June 30, 2023, incorporated in the capitation rates through a separate payment term of up to $2.88 billion.
Approval Date:
Effective Date:
Links:
State Rating Period:
Payment Type:
Fee schedule
Provider Class:
Inpatient hospital service, Outpatient hospital service
Review Type: Amendment
Approval Period: Single Rating Period
SDP Identifier:: VA_Fee_IPH.OPH.NF_Renewal_20230701-20230930
State: Virginia
Summary:
Uniform increase for inpatient and outpatient services rendered by non-state government owned acute care hospitals for the rating period covering July 1, 2023 through September 30, 2023, incorporated in the capitation rates through a separate payment term of up to $21,325,000.
Approval Date:
Effective Date:
Links:
State Rating Period:
Payment Type:
Fee schedule
Provider Class:
Inpatient hospital service, Nursing facility services, Outpatient hospital service
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: VA_Fee_AMC_Renewal_202301001-20240630
State: Virginia
Summary:
Uniform increase for physicians affiliated with the practice plans of Virginia’s three allopathic medical schools: University of Virginia, Virginia Commonwealth University, and Eastern Virginia Medical Center, for the rating period covering October 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $201,075,000.
Approval Date:
Effective Date:
Links:
State Rating Period:
Payment Type:
Fee schedule
Provider Class:
Professional services at an academic medical center
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: VA_Fee_Oth2_Renewal_20230101-20240630
State: Virginia
Summary:
Uniform increase established by the state for physicians employed by or contracted with the non-state government owned general acute care academic medical center for the rating period covering October 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $1,297,500.
Approval Date:
Effective Date:
Links:
State Rating Period:
Payment Type:
Fee schedule
Provider Class:
Other
Review Type: Renewal
Approval Period:
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