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 510
SDP Identifier:: PA_VBP_OPH_Renewal_20230101-20231231
State: Pennsylvania
Summary: Value-based payment arrangement for opioid use disorder for private acute care hospitals 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 $35 million.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Value-based payment
Provider Class:
Outpatient hospital service
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: PA_VBP_NF2_Renewal_20230101-20231231
State: Pennsylvania
Summary: Nursing Facility Quality Incentive established by the state 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 $15 million.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Value-based payment
Provider Class:
Nursing facility services
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: TN_Fee_IPH.OPH2_Renewal_20230101-20231231
State: Tennessee
Summary: Minimum and maximum fee schedules established by the state for select inpatient and outpatient services provided at eligible hospitals 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:
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:: WV_Fee_IPH.OPH.AMC_Renewal_20220701-20230630
State: West Virginia
Summary: Uniform Increase for eligible Acute Care Hospitals established by the state for Inpatient, Outpatient, and Physician Services for the rating period covering July 1, 2022 through June 30, 2023, incorporated in the capitation rates through a separate payment term of up to $343,997,344.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Inpatient hospital service, Outpatient hospital service, Professional services at an academic medical center
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: PA_Fee_IPH.OPH_New_20230101-20231231
State: Pennsylvania
Summary: Uniform increase for inpatient and outpatient hospital services established by the state 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 $1.156 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:: OR_Fee_OTH_Renewal_20230101-20231231
State: Oregon
Summary: Uniform increase established by the state for ground emergency medical transportation services 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 $20,531,555.
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:: MD_Fee.VBP_AMC.PC.SP_Amend_20220101-20241231
State: Maryland
Summary: Uniform percentage increase and value-based payment established by the state for professional services at an academic medical center, primary care services, specialty physician services, and qualifying practitioner services for the rating period covering January 1, 2022 through December 31, 2024 incorporated in the capitation rates through a separate payment term of up to $37.8 million.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule, Value-based payment
Provider Class:
Primary care services, Professional services at an academic medical center, Specialty physician services
Review Type: Amendment
Approval Period: Multiple Rating Period
SDP Identifier:: PR_Fee_SP.BHO_Renewal_20230101-20230930
State: Puerto Rico
Summary:
Minimum fee schedules for specialty physician services and behavioral health outpatient services for the rating periods covering January 1, 2023 through September 30, 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:
Behavioral health outpatient services, Specialty physician services
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: NC_Fee_AMC_Amend_20220701-20230630
State: North Carolina
Summary: Uniform dollar increase established by the state for the professional services at academic medical centers for the rating period covering July 1, 2022 through June 30, 2023 incorporated in the capitation rates through a separate payment term of up to $89,528,544.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Professional services at an academic medical center
Review Type: Amendment
Approval Period: Single Rating Period
SDP Identifier:: PA_Fee_Oth3_Renewal_20230101-20231231
State: Pennsylvania
Summary: Alternative fee schedule for ambulance services owned and operated by the Cities of Pittsburgh and Philadelphia 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:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Other
Review Type: Renewal
Approval Period: Single Rating Period
Results per page