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Approved State Directed Payment Preprints

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.

Results

Displaying 1 - 10 of 776

New Mexico

Renewal of a value-based purchasing and uniform percent increase arrangement established by the state to increase nursing facility per diem rates by the market basket index (MBI) factor and to provide quality incentive payments for nursing facilities that meet performance requirements on specified quality metrics for the rating period covering July 1, 2025 through December 31, 2025, incorporated into the capitation rates through a risk-based adjustment.

Approval Date: June 25, 2025
Effective Date: July 1, 2025
State Rating Period: July 1, 2025 - December 31, 2025
Payment Type: Fee schedule Value-based payment
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Nursing facility services

Tennessee

Uniform percentage increase established by the state for nursing facility services for the rating period, January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term of up to $80,545,210.00.

Approval Date: June 25, 2025
Effective Date: January 1, 2025
State Rating Period: January 1, 2025 - December 31, 2025
Payment Type: Fee schedule
Review Type: Amendment
Approval Period: Single Rating Period
Provider Class: Nursing facility services

Nebraska

Uniform increase for non-state owned or operated hospitals established by the state for inpatient and outpatient hospital services for the rating period, January 1, through December 31, 2024, incorporated into the capitation rates through a separate payment term of up to $705,533,735.

Approval Date: June 24, 2025
Effective Date: July 1, 2024
State Rating Period: January 1, 2024 - December 31, 2024
Payment Type: Fee schedule
Review Type: New
Approval Period: Single Rating Period
Provider Class: Inpatient hospital service Outpatient hospital service

Maryland

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, 2025 through December 31, 2025 incorporated in the capitation rates through a separate payment term amount up to $42 million.

Approval Date: June 23, 2025
Effective Date: January 1, 2025
State Rating Period: January 1, 2025 - December 31, 2025
Payment Type: Fee schedule
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Primary care services Professional services at an academic medical center Specialty physician services

Massachusetts

Maximum Fee Schedule for MassHealth contracted acute hospitals (except for specialty cancer hospitals and freestanding pediatric hospitals for an inpatient discharge with a MassHealth DRG Weight of 3 or greater) 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: June 23, 2025
Effective Date: January 1, 2025
State Rating Period: January 1, 2025 - December 31, 2025
Payment Type: Fee schedule
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Inpatient hospital service Outpatient hospital service

Missouri

Uniform dollar increase for government-owned or operated ground ambulance providers for the rating period covering July 1, 2025, through June 30, 2026, incorporated in the capitation rates through a separate payment term amount of up to $82,280,786.

Approval Date: June 23, 2025
Effective Date: July 1, 2025
State Rating Period: July 1, 2025 - June 30, 2026
Payment Type: Fee schedule
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Other

Missouri

Maximum fee schedule for inpatient and outpatient hospital services established by the state 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: June 23, 2025
Effective Date: July 1, 2024
State Rating Period: July 1, 2024 - June 30, 2025
Payment Type: Fee schedule
Review Type: New
Approval Period: Single Rating Period
Provider Class: Inpatient hospital service Outpatient hospital service

Louisiana

Fee schedule and value-based payment arrangement for behavioral health and home and community-based services providers for the rating period covering January 1, 2024through December 31, 2024.

Approval Date: June 23, 2025
Effective Date: January 1, 2024
State Rating Period: January 1, 2024 - December 31, 2024
Payment Type: Value-based payment
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Behavioral health outpatient services HCBS/personal care services

Maryland

Population-based payment for primacy care services 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: June 23, 2025
Effective Date: July 1, 2025
State Rating Period: January 1, 2025 - December 31, 2025
Payment Type: Value-based payment
Review Type: New
Approval Period: Single Rating Period
Provider Class: Primary care services

Maryland

Minimum Fee Schedule for primary care services for the rating period covering January1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.

Approval Date: June 23, 2025
Effective Date: July 1, 2025
State Rating Period: January 1, 2025 - December 31, 2025
Payment Type: Fee schedule
Review Type: New
Approval Period: Single Rating Period
Provider Class: Primary care services