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 41 - 50 of 677
SDP Identifier:: MA_VBP_IPH.OPH4_Renewal_20230401-20241231
State: Massachusetts
Summary:
Continuous Quality Improvement (CQI) value-based payment arrangement established by the state for private acute hospitals for the rating period covering April 1, 2023 through December 31, 2024, incorporated into the capitation rates through a separate payment term of up to $104,200,00 for April 1, 2023 to December 31, 2023 and up to $147,000,000 for January 1, 2024 to December 31, 2024.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Value-based payment
Provider Class:
Inpatient hospital service, Outpatient hospital service
Review Type: Renewal
Approval Period: Multiple Rating Period
SDP Identifier:: MA_Fee_BHO_Renewal_20240101-20241231
State: Massachusetts
Summary:
Uniform increase established by the State for Behavioral Health Urgent Care (BHUC) 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:: PA_VBP_OPH_Amend_20230101-20231231
State: Pennsylvania
Summary:
The 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 into the capitation rates through a separate payment term up to $35 million.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Value-based payment
Provider Class:
Outpatient hospital service
Review Type: Amendment
Approval Period: Single Rating Period
SDP Identifier:: VA_Fee_IPH.OPH_Amend_20240701-20250630
State: Virginia
Summary:
Uniform increase for inpatient and outpatient services at private acute care hospitals for the rating period covering July 1, 2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term of up to $3.22 billion.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Inpatient hospital service, Outpatient hospital service
Review Type: Amendment
Approval Period: Single Rating Period
SDP Identifier:: DC_Fee_IPH_New_20231001-20240930
State: District of Columbia
Summary:
The maximum fee schedule for inpatient hospital services established by the state for the rating period, October 1, 2023 through September 30, 2024, incorporated into 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
Review Type: New
Approval Period: Single Rating Period
SDP Identifier:: RI_VBP_Oth_Renewal_20240701-20250630
State: Rhode Island
Summary:
The Total Cost of Care payment arrangement for the state’s Accountable Entities, as authorized in the state’s section 1115 demonstration for the rating period covering July 1,2024 through June 30, 2025, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Value-based payment
Provider Class:
Other
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: WA_Fee_Oth_Renewal_20250101-20251231
State: Washington
Summary:
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, 2025 through December 31, 2025, 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_BHI.BHO3_Renewal_20250101-20251231
State: Washington
Summary:
Uniform increase established by the state for behavioral health inpatient and outpatient services delivered by eligible providers for the rating period covering January 1, 2025 through December 31, 2025, 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: 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
SDP Identifier:: KY_Fee.VBP_IPH.OPH_Renewal_20250101-20251231
State: Kentucky
Summary:
Uniform increase and value-based payment established by the state for inpatient and outpatient hospital services for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $2,412,721,014.
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
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