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Approved State Directed Payment Preprints

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.

Results

Displaying 251 - 260 of 742

New Mexico

Renewal of the uniform dollar increase for inpatient and outpatient hospital services and performance-based quality payments established by the state for the State Teaching Hospital that provides guaranteed access to care for Native Americans for the rating period covering January 1, 2024 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $155 million.

Approval Date: July 10, 2024
Effective Date: January 1, 2024
State Rating Period: January 1, 2024 - June 30, 2024
Payment Type: Value-based payment
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Inpatient hospital service Outpatient hospital service

Tennessee

Uniform percentage increase established by the state for nursing facility services for the rating period, January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $89,005,752.

Approval Date: July 9, 2024
Effective Date: January 1, 2024
State Rating Period: January 1, 2024 - December 31, 2024
Payment Type: Fee schedule
Review Type: Amendment
Approval Period: Single Rating Period
Provider Class: Nursing facility services

Florida

Uniform percentage increase established by the state for eligible inpatient and outpatient hospital services, excluding cancer hospitals, for the rating period, October 1, 2023 through September 30, 2024, incorporated into the capitation rates through a separate payment term up to $3,362,969,548.

Approval Date: July 9, 2024
Effective Date: October 1, 2023
State Rating Period: October 1, 2023 - September 30, 2024
Payment Type: Fee schedule
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Inpatient hospital service Outpatient hospital service

New York

Uniform increase for Sole Community Hospitals as established by the state for outpatient services for the rating period, April 1, 2024 through March 31, 2025, incorporated into the capitation rates through a separate payment term up to $121,377,916.

Approval Date: July 9, 2024
Effective Date: April 1, 2024
State Rating Period: April 1, 2024 - March 31, 2025
Payment Type: Fee schedule
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Outpatient hospital service

New York

Uniform increase for Critical Access Hospitals as established by the state for outpatient services for the rating period, April 1, 2024 through March 31, 2025, incorporated into the capitation rates through a separate payment term up to $49,576,895.

Approval Date: July 9, 2024
Effective Date: April 1, 2024
State Rating Period: April 1, 2024 - March 31, 2025
Payment Type: Fee schedule
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Outpatient hospital service

Massachusetts

The Hospital Quality Incentive proposal for the rating period covering January 1, 2023 through March 31, 2023, incorporated in the capitation rates through a separate payment term of up to $37.5 million.

Approval Date: July 2, 2024
Effective Date: January 1, 2023
State Rating Period: January 1, 2023 - March 31, 2023
Payment Type: Value-based payment
Review Type: New
Approval Period: Single Rating Period
Provider Class: Inpatient hospital service Outpatient hospital service

Massachusetts

Uniform increase established by the state for eligible home and community-based service (HCBS) providers for the rating period covering April 1, 2023 through December 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.

Approval Date: July 2, 2024
Effective Date: April 1, 2023
State Rating Period: April 1, 2023 - December 31, 2023
Payment Type: Fee schedule
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: HCBS/personal care services

Massachusetts

Uniform increase established by the state for eligible home and community-based service (HCBS) providers for the rating period covering January 1, 2023 through December 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.

Approval Date: July 2, 2024
Effective Date: January 1, 2023
State Rating Period: January 1, 2023 - December 31, 2023
Payment Type: Fee schedule
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: HCBS/personal care services

Mississippi

Uniform percentage increase and performance improvement initiative payments established by the state for inpatient and outpatient hospital services for the rating period covering July 1, 2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term of up to $1,565,840,324.

Approval Date: June 26, 2024
Effective Date: July 1, 2024
State Rating Period: July 1, 2024 - June 30, 2025
Payment Type: Fee schedule Value-based payment
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Inpatient hospital service Outpatient hospital service

New York

Minimum fee schedules established by the state for eligible primary care providers who have active New York State Patient Centered Medical Home (PCMH) recognition for assigned members for the rating period, April 1, 2024 through March 31, 2025, incorporated into the capitation rates through a separate payment term up to $203,730,871.

Approval Date: June 26, 2024
Effective Date: April 1, 2024
State Rating Period: April 1, 2024 - March 31, 2025
Payment Type: Fee schedule
Review Type: New
Approval Period: Single Rating Period
Provider Class: Primary care services