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 677
SDP Identifier:: MA_Fee_BHO3_Renewal_20230101-20231231
State: Massachusetts
Summary:
Uniform increase established by the State for Behavioral Health Urgent Care (BHUC) 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:
Behavioral health outpatient services
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: MA_Fee_BHO.Oth3_Renewal_20230101-20231231
State: Massachusetts
Summary:
Minimum fee schedule established by the State for outpatient behavioral health services and behavioral health diversionary services for the rating period covering January 1, 2023 through December 31, 2023, provided by the MA Behavioral Health Partnership, Senior Care Options (SCO), or One Care plans, and 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, Other
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: MA_Fee_Oth2_Renewal_20230101-20231231
State: Massachusetts
Summary:
The minimum fee schedule for Acute Treatment Services (ATS) and Clinical Support Services (CSS) (which may include individualized treatment services in a specialized setting), and Residential Rehabilitation Services (RRS) services established by the state for the rating period covering January 1, 2023 through December 31, 2023, incorporated into the capitation rates through a risk-based 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:: MI_Fee_HCBS3_Renewal_20241001-20250930
State: Michigan
Summary:
The uniform dollar increase established by the state for direct care workers providing personal care services to eligible enrollees for the rating period covering October 1, 2024 through September 30, 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:
HCBS/personal care services
Review Type: Renewal
Approval Period: Single Rating Period
SDP Identifier:: PR_Fee_SP.BHO_Amend_20231001-20240930
State: Puerto Rico
Summary:
Minimum fee schedule established by the state for eligible specialty physician services that are covered at 100% of Medicare and eligible behavioral health outpatient services that are covered at 80% of Medicare consistent with the requirements of the
Consolidated Appropriations Act of 2023 for the rating period covering October 1, 2023 through September 30, 2024 incorporated in the capitation rates through a risk-based adjustment.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Behavioral health outpatient services, Specialty physician services
Review Type: Amendment
Approval Period: Single Rating Period
SDP Identifier:: KY_Fee_Oth_Renewal_20250101-20251231
State: Kentucky
Summary:
Uniform dollar increase established by the state for emergency ground ambulance providers 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$62,463,235.
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:: NY_VBP_PC_New_20240401-20250331
State: New York
Summary:
Population-based payment established by the state for Medicaid managed care enrollees attributed to eligible primary care providers who have active New York State Patient Centered Medical Home (PCMH) recognition for the rating period, April 1, 2024 through March 31, 2025, incorporated into the capitation rates through a separate payment term up to $132,600,000.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Value-based payment
Provider Class:
Primary care services
Review Type: New
Approval Period: Single Rating Period
SDP Identifier:: NM_VBP.Fee_IPH.OPH_Renewal_20240701-20241231
State: New Mexico
Summary:
Renewal of the uniform dollar increase for inpatient and outpatient hospital services and performance-based quality payments established by the state for the State Teaching Hospital that provides guaranteed access to care for Native Americans for the rating period covering July 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $155 million.
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: Single Rating Period
SDP Identifier:: WV_Fee_IPH.OPH.AMC.PC_Amendment_20230701-20240630
State: West Virginia
Summary:
The Uniform Increase for eligible Acute Care Hospitals established by the state for Inpatient, Outpatient, and Physician Services for the rating period covering July 1, 2023through June 30, 2024, 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, Primary care services, Professional services at an academic medical center
Review Type: Amendment
Approval Period: Single Rating Period
SDP Identifier:: GA_Fee_OPH.PC.SP.BHO.D.Oth_New_20230701-20240630
State: Georgia
Summary:
Uniform percentage increase for outpatient hospital services, primary care services, specialty physician services, behavioral health outpatient services, dental services, and providers providing EPSDT services, established by the state for the rating period covering July 1, 2023, through June 30, 2024, incorporated in the capitation rates through a rate adjustment of up to $5,700,000.
Approval Date:
Effective Date:
Links:
State Rating Period:
-
Payment Type:
Fee schedule
Provider Class:
Behavioral health outpatient services, Dental services, Other, Outpatient hospital service, Primary care services, Specialty physician services
Review Type: New
Approval Period: Single Rating Period
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