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
Uniform increase for professional services furnished by eligible physician practices 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 $38 million.
Approval Date:
May 22, 2025
Effective Date:
January 1, 2025
Links:
State Rating Period:
January 1, 2025
-
December 31, 2025
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Professional services at an academic medical center
Washington
Uniform percentage increase established by the state for behavioral health outpatient services for Medicaid-enrolled managed care enrollees delivered by PACT teams (Program of Assertive Community Treatment) 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:
May 22, 2025
Effective Date:
January 1, 2025
Links:
State Rating Period:
January 1, 2025
-
December 31, 2025
Payment Type:
Fee schedule
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Behavioral health outpatient services
Wisconsin
Uniform percentage increase established by the state for eligible home and community-based services for the rating period, January 1, 2024 through December 31, 2024,incorporated into the capitation rates through a separate payment term of up to$151,500,000.
Approval Date:
May 22, 2025
Effective Date:
January 1, 2025
Links:
State Rating Period:
January 1, 2024
-
December 31, 2024
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
HCBS/personal care services
South Carolina
Uniform increase established by the state for emergency medical transport services provided by public and government-owned or operated ambulance service providers for rating periods covering July 1, 2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term amount of up to $3,118,148.
Approval Date:
May 22, 2025
Effective Date:
January 1, 2025
Links:
State Rating Period:
July 1, 2024
-
June 30, 2025
Payment Type:
Fee schedule
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Other
Tennessee
Value-based payment and uniform percentage increase established by the state for professional services at an academic medical center for the rating period, January 1,2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term of up to $15,741,366.
Approval Date:
May 22, 2025
Effective Date:
January 1, 2025
Links:
State Rating Period:
January 1, 1025
-
December 31, 2025
Payment Type:
Fee schedule
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Professional services at an academic medical center
Massachusetts
Minimum fee schedule for psychiatric services for enrollees under the age of 21 with Autism Spectrum Disorder or Intellectual or Developmental Disability (ASD/IDD) for the rating period covering January 1, 2023 through September 30, 2023, provided by the state’s Prepaid Inpatient Health Plan (PIHP), incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
May 16, 2025
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
December 31, 2023
Payment Type:
Fee schedule
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Behavioral health inpatient service
Nevada
Uniform percentage increase for inpatient and outpatient hospital services at non-state governmentally owned hospitals 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 $197,169,083.
Approval Date:
May 15, 2025
Effective Date:
January 1, 2025
Links:
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
South Carolina
Uniform increase established by the state for emergency medical transport services provided by ground non-governmental ambulance services providers for rating periods covering July 1, 2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term amount of up to $8,183,729.
Approval Date:
May 15, 2025
Effective Date:
January 1, 2025
Links:
State Rating Period:
July 1, 2024
-
June 30, 2025
Payment Type:
Fee schedule
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Other
Delaware
Uniform percentage increase established by the state for personal care service claims 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:
May 9, 2025
Effective Date:
January 1, 2025
Links:
State Rating Period:
January 1, 2025
-
December 31, 2025
Payment Type:
Fee schedule
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
HCBS/personal care services
Illinois
Uniform dollar increase for nursing facilities based on quality weighted Medicaid days for the rating period covering January 1, 2022 through December 31, 2022, and incorporated in the capitation rates through a separate payment term of up to $29million.
Approval Date:
May 8, 2025
Effective Date:
July 1, 2022
Links:
State Rating Period:
January 1, 2022
-
December 31, 2022
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Nursing facility services