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
Tennessee
Uniform percentage increase for professional services at an academic medical center for rating periods covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term amount up to $15,741,366.
Approval Date:
June 22, 2026
Effective Date:
January 1, 2025
Links:
Tennessee
Uniform percentage increase for nursing facility services for rating periods covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term amount up to $80,545,210.
Approval Date:
June 22, 2026
Effective Date:
January 1, 2025
Links:
Virginia
Uniform percentage increase for professional services at an academic medical center, primary care services, and specialty physician services for rating periods covering July 1,2026 through June 30, 2027, incorporated in the capitation rates through a separate payment term amount of up to $7,885,485.
Approval Date:
June 18, 2026
Effective Date:
July 1, 2026
Links:
Virginia
Uniform percentage increase for professional services at an academic medical center, primary care services, and specialty physician services related to physicians employed by or contracted by a private acute care type 2 hospital system with at least one level 2 trauma center as of January 2022 located in Lord Fairfax Health District and Northwest Health Planning Region for rating periods covering July 1, 2026 through June 30, 2027, incorporated in the capitation rates through a separate payment term amount of up to $4,608,437.
Approval Date:
June 18, 2026
Effective Date:
July 1, 2026
Links:
California
Uniform dollar increase established by the state for dental services for the rating period covering January 1, 2026 through June 30, 2026, incorporated in the capitation rates through a risk-based rate adjustment of up to $17,703,500.
Approval Date:
June 17, 2026
Effective Date:
January 1, 2026
Links:
Washington
Approval Date:
June 17, 2026
Effective Date:
January 1, 2026
Links:
North Carolina
Minimum Fee Schedule established by the state for eligible non-state government owned skilled nursing facility admission days based on actual utilization services for the rating period covering July 1, 2026 through June 30, 2027, incorporated in the capitation rates through a risk-based rate adjustment of up to $5,650,000.
Approval Date:
June 16, 2026
Effective Date:
July 1, 2026
Links:
Virginia
Quality Payment/Pay for Performance for nursing facility services for rating periods covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term amount of up to $184,900,000.
Approval Date:
June 16, 2026
Effective Date:
July 1, 2026
Links:
Ohio
Uniform percentage increase for qualified practitioner services at an academic medical center, primary care and specialty physician services, and dental services, as well as a value-based performance payment to providers who attain quality performance target(s), for the rating period covering January 1, 2026 through December 31, 2026, incorporated into capitation rates via a separate payment term up to $23,716,304.
Approval Date:
June 12, 2026
Effective Date:
January 1, 2026
Links:
State Rating Period:
January 1, 2026
-
December 31, 2026
Payment Type:
Fee schedule
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Dental services
Other
Primary care services
Professional services at an academic medical center
Specialty physician services
Florida
Uniform percentage increase for professional services at an academic medical center for the rating period covering October 1, 2025 through September 30, 2026, incorporated in the capitation rates through a separate payment term amount up to $442,867,123.
Approval Date:
June 9, 2026
Effective Date:
October 1, 2025
Links: