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 111 - 120 of 641
SDP Identifier:: NY_VBP_OTH4_Renewal_20240401-20250331
State: New York
Summary:
The value-based payment arrangement established by the state for Behavioral Health Independent Practice Associations delivering behavioral health outpatient and HCBS services for the rating period covering April 1, 2024 – March 31, 2025, incorporated into the capitation rates through a separate payment term of up to $10,000,000.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Value-based payment
Provider Class:
Other
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: RI_Fee_IPH4_Renewal_20240701-20250630
State: Rhode Island
Summary:
Uniform increase established by the state for inpatient hospital services for the rating period covering July 1, 2024 through June 30, 2025, incorporated into 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_SP_Renewal_20240701-20250630
State: Virginia
Summary:
Uniform increase for physician services provided by physicians who participate in Children’s Specialty Group, affiliated with Children’s Hospital of the King’s Daughters, for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $11,050,000.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Specialty physician services
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: OH_Fee_AMC.PC.SP.Oth1_Amend_20240101-20241231
State: Ohio
Summary:
The uniform percentage increase for participating health systems affiliated with a public medical school established by the state for qualified practitioners for the rating period January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a risk based adjustment and a separate payment term up to $1,000,000.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Other, Primary care services, Professional services at an academic medical center, Specialty physician services
Review Type: Amendment
Approval Period: Single Rating Period
SDP Identifier:: OH_Fee_AMC.PC.SP.Oth2_Amend_20240101-20241231
State: Ohio
Summary:
The uniform percentage increase for participating health systems affiliated with a public medical school in Northeast class established by the state for qualified practitioners for the rating period January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a risk based adjustment and a separate payment term up to $3,385,000.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Other, Primary care services, Professional services at an academic medical center, Specialty physician services
Review Type: Amendment
Approval Period: Single Rating Period
SDP Identifier:: MA_VBP_OPH_New_20230401-20241231
State: Massachusetts
Summary:
The Hospital Quality Incentive proposal for the rating period covering April 1, 2023 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $75 million each year for 2023 and 2024 rating years.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Value-based payment
Provider Class:
Outpatient hospital service
Review Type: New
Approval Period: Single Rating Period
SDP Identifier:: RI_Fee_IPH_Renewal_20240701-20250630
State: Rhode Island
Summary:
Uniform increase established by the state for inpatient hospital services for the rating period covering July 1, 2024 through June 30, 2025, incorporated into 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:: MA_VBP_IPH.OPH5_Renewal_20230401-20241231
State: Massachusetts
Summary:
The Hospital Quality Incentive proposal for the rating period covering April 1, 2023 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $87.5 million for April 1, 2023 through December 31, 2023 and $125 million for rating year 2024.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Value-based payment
Provider Class:
Inpatient hospital service, Outpatient hospital service
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: NY_Fee_OPH3_New_20230401-20240331
State: New York
Summary:
Uniform increase for Government general hospitals as established by the state, other than those operated by the State of New York or the State University of New York, located in a city with a population of over one million, for outpatient hospital services for the rating period, April 1, 2023 through March 31, 2024, incorporated into the capitation rates through a separate payment term up to $900,800,521.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Outpatient hospital service
Review Type: New
Approval Period: Single Rating Period
SDP Identifier:: NY_Fee_HCBS_Renewal_20230401-20240331
State: New York
Summary:
The enhanced minimum fee schedule for home and community-based services approved through the state’s 1115 waiver for the rating period, April 1, 2023 through March 31, 2024, incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
HCBS/personal care services
Review Type: Renewal
Approval Period: Single Rating Period
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