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
Pennsylvania
Value-based payment arrangement for opioid use disorder for private acute care hospitals for the rating period covering January 1, 2023 through December 31, 2023, incorporated in the capitation rates through a separate payment term of up to $35 million.
Approval Date:
February 3, 2023
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
December 31, 2023
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Outpatient hospital service
Pennsylvania
Nursing Facility Quality Incentive established by the state for the rating period covering January 1, 2023 through December 31, 2023, incorporated in the capitation rates through a separate payment term of up to $15 million.
Approval Date:
February 3, 2023
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
December 31, 2023
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Nursing facility services