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 321 - 330 of 677
SDP Identifier:: NJ_VBP_IPH.OPH_Renewal_20240701-20250630
State: New Jersey
Summary:
A pay-for-performance initiative focused on maternal health performance improvement among acute care hospitals licensed to provide Labor and Delivery Services for the rating period covering July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term of up to $63,000,000.
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:: NC_Fee_NF_New_20220701-20230630
State: North Carolina
Summary:
Minimum fee schedule for non-state government owned skilled nursing facility admission days for the rating period, July 1, 2022 through June 30, 2023, incorporated into the capitation rates through an adjustment to base rates.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Nursing facility services
Review Type: New
Approval Period: Single Rating Period
SDP Identifier:: AZ_Fee_HCBS.BHO1_Renewal_20221001-20230930
State: Arizona
Summary:
Uniform percentage increase to registered providers who provide qualifying HCBS and Behavioral Health Outpatient services for the rating period, October 1, 2022 through September 30, 2023, incorporated into the capitation rates through a separate payment term up to $385.1 million.
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
SDP Identifier:: OH_Fee_IPH.OPH.Oth1_Renewal_20240101-20241231
State: Ohio
Summary:
Uniform increase established by the state for inpatient and outpatient services provided by in-state hospitals for the rating period covering January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $1.762 billion.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Inpatient hospital service, Outpatient hospital service
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: OH_Fee_IPH.OPH.Oth2_Renewal_20240101-20241231
State: Ohio
Summary:
Uniform percentage increase for inpatient and outpatient services at the University of Toledo Medical Center for the rating period covering January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $44,400,000.00.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Inpatient hospital service, Outpatient hospital service
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: PR_Fee_D_Renewal_20231001-20240930
State: Puerto Rico
Summary:
Minimum fee schedule established by the state for dental services for the rating period covering October 1, 2023 through September 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:
Dental services
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: PR_Fee_PC_Renewal_20231001-20240930
State: Puerto Rico
Summary:
Minimum fee schedule established by the state for eligible primary care services for the rating period covering October 1, 2023 through September 30, 2024 incorporated in the capitation rates through a risk-based adjustment.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Primary care services
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: PR_Fee_PC1_Renewal_20231001-20240930
State: Puerto Rico
Summary:
Minimum fee schedule established by the state for primary care services that are covered at 75% of Medicare consistent with the requirements of the Consolidated Appropriations Act of 2023 for the rating period covering October 1, 2023 through September 30, 2024 incorporated in the capitation rates through a risk-based adjustment.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Primary care services
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: RI_VBP_Oth_Renewal_20230701-20240630
State: Rhode Island
Summary:
The Total Cost of Care for the state’s Accountable Entities, as authorized in the state’s section 1115 demonstration, for the rating period covering July 1, 2023 through June 30, 2024.
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:: TN_Fee_IPH.OPH3_Renewal_20240101-20241231
State: Tennessee
Summary:
Uniform percentage increase established by the state for eligible inpatient and outpatient hospital services for the rating period, January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $344,047,623.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Inpatient hospital service, Outpatient hospital service
Review Type: Renewal
Approval Period: Single Rating Period
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