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 351 - 360 of 677
SDP Identifier:: MA_Fee_IPH.OPH3_Renewal_20220101-20221231
State: Massachusetts
Summary:
Maximum Fee Schedule for MassHealth contracted acute hospitals (except for specialty cancer hospitals, freestanding pediatric hospitals for an inpatient discharge with a MassHealth DRG Weight of 3 or greater, and the acute hospital with a pediatric specialty unit for enrollees under the age of 21 at the time of admission for an inpatient discharge with a MassHealth DRG Weight of 3 or greater) for the rating period covering January 1, 2022 through December 31, 2022, 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, Outpatient hospital service
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: MA_Fee_IPH.OPH3_Renewal_20230101-20230331
State: Massachusetts
Summary:
Maximum Fee Schedule for MassHealth contracted acute hospitals (except for specialty cancer hospitals, freestanding pediatric hospitals for an inpatient discharge with a MassHealth DRG Weight of 3 or greater, and the acute hospital with a pediatric specialty unit for enrollees under the age of 21 at the time of admission for an inpatient discharge with a MassHealth DRG Weight of 3 or greater) for the rating period covering January 1, 2023 through March 31, 2023, 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, Outpatient hospital service
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: CA_Fee_D_Renewal_20240101-20241231
State: California
Summary:
Uniform dollar increase established by the state for dental services for the rating period covering January 1, 2024 through December 31, 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:
Dental services
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: CA_Fee_IPH.OPH.NF_Renewal_20240101-20241231
State: California
Summary:
Uniform dollar increase established by the state for inpatient and outpatient hospital services at District Hospitals for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $207,290,924.
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:: WI_Fee_BHO_Renewal_20240101-20241231
State: Wisconsin
Summary:
Minimum and maximum fee schedule for Sub-Acute Psychiatric Community-Based Psychiatric and Recovery Center Services for the rating period covering January 1, 2024 through December 31, 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:
Behavioral health outpatient services
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: CA_Fee_Oth1_Renewal_20240101-20241231
State: California
Summary:
Uniform dollar increase established by the state for developmental screening services for the rating period covering January 1, 2024 through December 31, 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:: CA_Fee_Oth2_Renewal_20240101-20241231
State: California
Summary:
Uniform dollar increase established by the state for Family Planning services for the rating period covering January 1, 2024 through December 31, 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:: CA_VBP_IPH.OPH_Amend_20210101-20231231
State: California
Summary:
Quality Incentive Pool for District and Municipal Public Hospital Systems for the rating periods covering January 1, 2021 through December 31, 2023, incorporated in the CY 2023 capitation rates through a separate payment term of up to $192,062,936.53.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Value-based payment
Provider Class:
Inpatient hospital service, Outpatient hospital service
Review Type: Amendment
Approval Period: Multiple Rating Period
SDP Identifier:: CA_VBP_IPH.OPH2_Amend_20210101-20231231
State: California
Summary:
Quality Incentive Pool for Designated Public Hospital systems for the rating periods covering January 1, 2021 through December 31, 2023, incorporated in the CY 2023 capitation rates through a separate payment term of up to $2,040,316,388.17.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Value-based payment
Provider Class:
Inpatient hospital service, Outpatient hospital service
Review Type: Amendment
Approval Period: Multiple Rating Period
SDP Identifier:: MA_VBP_IPH.OPH4_New_20230101-20230331
State: Massachusetts
Summary:
Continuous Quality Improvement (CQI) value-based payment arrangement established by the state for private acute hospitals for the rating period covering January 1, 2023 through March 31, 2023, incorporated into the capitation rates through a separate payment term of up to $37,876,200.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Value-based payment
Provider Class:
Inpatient hospital service, Outpatient hospital service
Review Type: New
Approval Period: Single Rating Period
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