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
Pennsylvania
Quality Payment/Pay for Performance (Category 2 APM, or similar) and Performance Improvement Initiative amendment for nursing facility 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 $15,000,000.
Approval Date:
August 20, 2026
Effective Date:
January 1, 2025
Links:
Pennsylvania
Minimum Fee Schedule for nursing facility services for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment of up to $1,850,000,000.
Approval Date:
June 2, 2026
Effective Date:
January 1, 2026
Links:
Pennsylvania
Quality Payment/Pay for Performance (Category 2 APM, or similar) and Performance Improvement Initiative for nursing facility services for rating periods covering January1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term amount of up to $15,000,000.
Approval Date:
April 23, 2026
Effective Date:
January 1, 2026
Links:
Pennsylvania
Uniform percentage increase for inpatient hospital and outpatient hospital services for rating periods covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term amount up to $2,335,007,317.
Approval Date:
March 18, 2026
Effective Date:
January 1, 2026
Links:
Pennsylvania
Uniform percentage increase for inpatient hospital and outpatient hospital services for rating periods covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term amount up to $424,720,803.
Approval Date:
March 18, 2026
Effective Date:
January 1, 2026
Links:
Pennsylvania
Quality Payment/Pay for Performance (Category 2 APM, or similar) and Performance Improvement Initiative for nursing facility services for rating periods covering January1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term amount of up to $15,000,000.
Approval Date:
March 18, 2026
Effective Date:
January 1, 2024
Links:
Pennsylvania
Minimum Fee Schedule for behavioral health inpatient service and behavioral health outpatient service for the rating period covering January 1, 2026 through December 31,2026, incorporated in the capitation rates through an alternative fee schedule of up to$633,562,966.
Approval Date:
January 30, 2026
Effective Date:
January 1, 2026
Links:
Pennsylvania
Uniform percentage increase for dental services for the rating period covering January 1,2026 through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment of up to $63,373,184.
Approval Date:
January 16, 2026
Effective Date:
January 1, 2026
Links:
Pennsylvania
Minimum Fee Schedule for Integrated Community Wellness Centers for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment of up to $49,874,341.00.
Approval Date:
January 13, 2026
Effective Date:
January 1, 2026
Links:
Pennsylvania
Uniform dollar amount for eligible providers that provide private duty nursing services to members under age 21 for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment of up to $1,712,374.
Approval Date:
December 4, 2025
Effective Date:
January 1, 2026
Links: