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 81 - 90 of 641
SDP Identifier:: HI_Fee_PC.SP.Oth_Renewal_20230101-20231231
State: Hawaii
Summary: Minimum fee schedule established by the state for primary care services, specialty physician services, obstetricians, gynecologists, nurse practitioners, advance practice registered nurses, and physician assistants as defined in the preprint 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, Primary care services, Specialty physician services
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: HI_VBP.Fee_IPH.OPH_Renewal_20240101-20241231
State: Hawaii
Summary:
- Pay for performance arrangement established by the state for public and private hospitals as defined in the preprint for the rating period covering January 1, 2024 through December 31, 2024 incorporated in the capitation rates through separate payment term of up to $46.15 million;
- Uniform dollar increase established by the state for safety net hospitals owned and operated by a government agency 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 $86.46 million;
- Uniform percentage increase established by the state for inpatient and outpatient hospital services within privately-owned hospital provider classes for the rating period covering January 1, 2024 to December 31, 2024 incorporated in the capitation rates through a separate payment term of up to $162.2 million; and,
- Minimum and Maximum fee schedule established by the state for in-state general acute hospitals and children’s hospital services within in-state general acute hospital provider classes for the rating period of January 1, 2024 to 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, Value-based payment
Provider Class:
Inpatient hospital service, Outpatient hospital service
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: HI_VBP.Fee_NF_Renewal_20240101-20241231
State: Hawaii
Summary:
- Pay for performance arrangement established by the state for public and private nursing facilities as defined in the preprint 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 $2.71 million; and,
- Uniform dollar increase established by the state for nursing facility services within government-owned nursing facilities 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 $32.96 million.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule, Value-based payment
Provider Class:
Nursing facility services
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: HI-VBP-Fee-IPH-OPH-Renewal-20230101-20231231
State: Hawaii
Summary:
• Pay for performance arrangement established by the state for public and private hospitals as defined in the preprint 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 $46.22 million;
• Uniform dollar increase established by the state for safety net hospitals owned and operated by a government agency 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 $78.1 million;
• Uniform percentage increase established by the state for inpatient and outpatient hospital services within privately-owned hospital provider classes for the rating period covering January 1, 2023 to December 31, 2023 incorporated in the capitation rates through a separate payment term of up to an estimated computable $166.69 million; and,
• Minimum and Maximum fee schedule established by the state for in-state general acute hospitals and children’s hospital services within in-state general acute hospital provider classes for the rating period of January 1, 2023 to December 31, 2023 incorporated in the capitation rates through a risk-based adjustment.
Approval Date:
Effective Date:
Links:
State Rating Period: -
Payment Type:
Fee schedule, Value-based payment
Provider Class:
Inpatient hospital service, Outpatient hospital service
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: HI-VBP-Fee-NF-Renewal-20230101-20231231
State: Hawaii
Summary:
• Pay for performance arrangement established by the state for public and private nursing facilities as defined in the preprint 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 $2.62 million;
• Uniform dollar increase established by the state for nursing facility services within government-owned nursing facilities 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 $32.14 million.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule, Value-based payment
Provider Class:
Nursing facility services
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: IA_Fee_AMC_Amend_20210701- 20220630
State: Iowa
Summary:
A uniform increase for physician and professional services at qualifying Iowa state- owned or operated professional services practices as defined in the Medicaid State Plan for the rating period covering July 1, 2021 through June 30, 2022, incorporated into the capitation rates through a separate payment term of up to $106,546,734.
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:: IA_Fee_AMC_Amend_20230701-20240630
State: Iowa
Summary:
A uniform increase for physician and professional services at qualifying Iowa state-owned or operated professional services practices as defined in the Medicaid State Plan for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $121,094,222.
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:: IA_Fee_AMC_Renewal_20230701-20240630
State: Iowa
Summary:
A uniform increase for physician and professional services at qualifying Iowa state-owned or operated professional services practices as defined in the Medicaid State Plan for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $116,808,663.
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:: IA_Fee_AMC_Renewal_20240701-20250630
State: Iowa
Summary:
Uniform increase for physician and professional services provided at qualifying Iowa state-owned or operated professional services practices as defined in the Medicaid State Plan for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $137,560,533.79.
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:: IA_Fee_HCBS.BHO_New_20240701-20250630
State: Iowa
Summary:
Uniform increase established by the state for eligible home and community based and behavioral health outpatient providers for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $27,000,000.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Behavioral health inpatient service, Behavioral health outpatient services, HCBS/personal care services
Review Type: New
Approval Period: Single Rating Period
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