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RI_Fee_IPH3_New_20220701-20230630

Submitted by tomoe.koketsu@… on
File - Approval Letter Media
RI_Fee_IPH3_New_20220701-20230630
Approval Date
Effective Date
State
Rhode Island
Payment Type
Fee schedule
Provider Class
Inpatient hospital service
Review Type
New
State Rating Period Start Date
Approval Period
Single Rating Period
State Rating Period End Date

RI_Fee_IPH_Renewal_20220701-20230630

Submitted by tomoe.koketsu@… on
File - Approval Letter Media
RI_Fee_IPH_Renewal_20220701-20230630
Approval Date
Effective Date
State
Rhode Island
Payment Type
Fee schedule
Provider Class
Inpatient hospital service
Review Type
Renewal
State Rating Period Start Date
Approval Period
Single Rating Period
State Rating Period End Date

RI_Fee_HCBS2_Renewal_20220701-20230630

Submitted by tomoe.koketsu@… on
File - Approval Letter Media
RI_Fee_HCBS2_Renewal_20220701-20230630
Approval Date
Effective Date
State
Rhode Island
Payment Type
Fee schedule
Provider Class
HCBS/personal care services
Review Type
Renewal
State Rating Period Start Date
Approval Period
Single Rating Period
State Rating Period End Date

NJ_Fee_IPH.OPH.AMC.PC.SP.BHI.BHO.D_Renewal_20230701-20240630

Submitted by tomoe.koketsu@… on
File - Approval Letter Media
NJ_Fee_IPH.OPH.AMC.PC.SP.BHI.BHO.D_Renewal_20230701-20240630
Approval Date
Effective Date
State
New Jersey
Payment Type
Fee schedule
Provider Class
Behavioral health inpatient service
Behavioral health outpatient services
Dental services
Inpatient hospital service
Outpatient hospital service
Primary care services
Professional services at an academic medical center
Specialty physician services
Review Type
Renewal
State Rating Period Start Date
Approval Period
Single Rating Period
State Rating Period End Date

MS_Fee_IPH.OPH_Renewal_20230701-20240630

Submitted by tomoe.koketsu@… on
File - Approval Letter Media
MS_Fee_IPH.OPH_Renewal_20230701-20240630
Approval Date
Effective Date
State
Mississippi
Payment Type
Fee schedule
Provider Class
Inpatient hospital service
Outpatient hospital service
Review Type
Renewal
State Rating Period Start Date
Approval Period
Single Rating Period
State Rating Period End Date

MS_Fee_IPH.OPH_Amend2_20220701-20230630

Submitted by tomoe.koketsu@… on
File - Approval Letter Media
MS_Fee_IPH.OPH_Amend2_20220701-20230630
Approval Date
Effective Date
State
Mississippi
Payment Type
Fee schedule
Provider Class
Inpatient hospital service
Outpatient hospital service
Review Type
Amendment
State Rating Period Start Date
Approval Period
Single Rating Period
State Rating Period End Date

MI_Fee_HCBS2_Renewal_20221001-20230930

Submitted by tomoe.koketsu@… on
File - Approval Letter Media
MI_Fee_HCBS2_Renewal_20221001-20230930
Approval Date
Effective Date
State
Michigan
Payment Type
Fee schedule
Provider Class
HCBS/personal care services
Review Type
Renewal
State Rating Period Start Date
Approval Period
Single Rating Period
State Rating Period End Date

MS_Fee_IPH.OPH_Amend_20210701-20220630

Submitted by tomoe.koketsu@… on
File - Approval Letter Media
MS_Fee_IPH.OPH_Amend_20210701-20220630
Approval Date
Effective Date
State
Mississippi
Payment Type
Fee schedule
Provider Class
Inpatient hospital service
Outpatient hospital service
Review Type
Amendment
State Rating Period Start Date
Approval Period
Single Rating Period
State Rating Period End Date

KY_Fee.Oth2_Renewal_20220101-20221231

Submitted by tomoe.koketsu@… on
File - Approval Letter Media
KY_Fee.Oth2_Renewal_20220101-20221231
Approval Date
Effective Date
State
Kentucky
Payment Type
Fee schedule
Provider Class
Other
Review Type
Renewal
State Rating Period Start Date
Approval Period
Single Rating Period
State Rating Period End Date
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