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 1 - 10 of 15
SDP Identifier:: WA_Fee_IPH.OPH2_New_20240101-20241231
State: Washington
Summary:
The uniform percentage increase established by the state for inpatient and outpatient hospital services provided by eligible Critical Access Hospitals and Prospective Payment System Hospitals for the rating period January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term up to $1.818 billion.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Inpatient hospital service, Outpatient hospital service
Review Type: New
Approval Period: Single Rating Period
SDP Identifier:: WA_Fee_IPH.OPH1_New_20240101-20241231
State: Washington
Summary:
Uniform percentage increase for inpatient and outpatient services with designated public hospitals established by the state for the rating period, January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $224.1 million.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Inpatient hospital service, Outpatient hospital service
Review Type: New
Approval Period: Single Rating Period
SDP Identifier:: WA_Fee_IPH.OPH3_Renewal_20240101-20241231
State: Washington
Summary:
Uniform increase for hospitals owned or operated by a state university established by the state for inpatient and outpatient hospital services for the rating period, January 1, 2024through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $433 million.
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:: WA_Fee_PC_Renewal_20240101-20241231
State: Washington
Summary:
Renewal of the uniform increase established by the state for primary care services for all eligible providers 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:
Primary care services
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: WA_Fee_BHI.BHO3_New_20240101-20241231
State: Washington
Summary:
The uniform increase established by the state for behavioral health inpatient and outpatient services delivered by eligible providers for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a through a risk-based adjustment.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Behavioral health inpatient service, Behavioral health outpatient services
Review Type: New
Approval Period: Single Rating Period
SDP Identifier:: WA_Fee_AMC_Renewal_20240101-20241231
State: Washington
Summary:
Renewal of a uniform increase established by the state for qualified licensed professionals employed by the University of Washington and/or a member of its affiliated physician practice plans or employed by a public hospital or other public entity 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 $109 million.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Professional services at an academic medical center
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: WA_Fee_BHO3_Renewal_20240101-20241231
State: Washington
Summary:
Renewal of the uniform increase established by the state for eligible providers delivering opioid treatment 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:
Behavioral health outpatient services
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: WA_Fee_OTH_Renewal_20240101-20241231
State: Washington
Summary:
Renewal of the uniform increase established by the state for publicly funded sexual and reproductive health family planning providers as designated by the Department of Health 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:: WA_Fee_BHI2.BHO2_Renewal_20240101-20241231
State: Washington
Summary:
Renewal of the uniform increase established by the state for behavioral health inpatient and behavioral health outpatient 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:
Behavioral health inpatient service, Behavioral health outpatient services
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: WA_Fee_AMC_Renewal_20230101-20231231
State: Washington
Summary: Uniform increase established by the state for qualified licensed professionals employed by the University of Washington and/or a member of its affiliated physician practice plans or employed by a public hospital or other public entity 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 $90 million.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Professional services at an academic medical center
Review Type: Renewal
Approval Period: Single Rating Period
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