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
Oregon
Uniform increase established by the state for behavioral health services furnished by qualified providers delivering services to members with co-occurring disorders (COD) for the rating period covering January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
November 27, 2024
Effective Date:
January 1, 2025
Links:
Rhode Island
The value-based payment Patient Centered Medical Home (PCMH)-Kids initiative established by the state for eligible pediatric providers for the rating period covering July1, 2024 through June 30, 2025, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
November 27, 2024
Effective Date:
July 1, 2024
Links:
Rhode Island
The uniform increase established by the state for nursing facility services 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:
November 27, 2024
Effective Date:
October 1, 2024
Links:
Washington
Uniform increase established by the state for behavioral health inpatient and outpatient services delivered by eligible providers for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a through a risk-based adjustment.
Approval Date:
November 27, 2024
Effective Date:
January 1, 2024
Links:
Washington
Uniform increase established by the state for behavioral health inpatient and behavioral health outpatient services for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
November 27, 2024
Effective Date:
January 1, 2024
Links:
Indiana
A uniform increase for nursing facilities established by the state based on Medicaid nursing facility utilization and quality performance metrics for the rating period July 1,2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $180.7 million.
Approval Date:
November 26, 2024
Effective Date:
July 1, 2024
Links:
Louisiana
Uniform dollar increase for pediatric home health nurses established by the state for home health services for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $3,307,280.
Approval Date:
November 26, 2024
Effective Date:
July 1, 2024
Links:
Louisiana
Uniform increase for non-emergency medical transport providers for the rating period covering July 1, 2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term of up to $2,800,584.
Approval Date:
November 26, 2024
Effective Date:
July 1, 2024
Links:
Massachusetts
The Hospital Quality Incentive proposal for non-federal, non-state owned, public hospitals for inpatient hospital services for the rating period covering April 1, 2023 through December 31, 2024 incorporated into the capitation rates through a separate payment term of up to $93.8 million for April 1, 2023 through December 31, 2023 and $160.8 million for January 1, 2024 through December 31, 2024.
Approval Date:
November 26, 2024
Effective Date:
April 1, 2023
Links:
No state
The Integrated Care Incentive proposal for inpatient and outpatient hospital services at non-federal, non-state-owned, public hospitals for the rating period covering April 1, 2023 through December 31, 2024 through a separate payment term of up to $86.8 million for April 1, 2023 through December 31, 2023 and $148.8 million for January 1, 2024 through December 31, 2024.
Approval Date:
November 26, 2024
Effective Date:
April 1, 2023
Links: