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
Missouri
Uniform percentage increases for the professional services of designated providers affiliated with one of the qualifying hospitals for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $68,300,368.37
Approval Date:
November 2, 2023
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
June 30, 2024
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
New York
The value-based performance improvement initiative for qualifying Social Adult Day Care (SADC) sites established by the state for social adult daycare services for the rating period covering April 1, 2023 through March 31, 2024, incorporated in the capitation rates through a separate payment term of up to $14 million.
Approval Date:
October 31, 2023
Effective Date:
April 1, 2023
Links:
State Rating Period:
April 1, 2023
-
March 31, 2024
Payment Type:
Value-based payment
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
HCBS/personal care services
New York
The uniform increase for qualifying hospitals established by the state for inpatient services for the rating period covering April 1, 2023 through March 31, 2024, incorporated into the capitation rates through a separate payment term of up to $650 million.
Approval Date:
October 31, 2023
Effective Date:
April 1, 2023
Links:
State Rating Period:
April 1, 2023
-
March 31, 2024
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Iowa
Uniform increase for all non-state owned or operated hospitals eligible to receive inpatient and/or outpatient payments consistent with the Medicaid State Plan for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $1,300,000,000.
Approval Date:
October 27, 2023
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
Iowa
Uniform increase established by the state for eligible ground emergency medical transportation providers for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
October 27, 2023
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Other
Missouri
Minimum and maximum fee schedules established by the state for inpatient hospital services for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
October 27, 2023
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Virginia
Uniform increase for inpatient and outpatient services at private acute care hospitals for the rating period covering July 1, 2022 through June 30, 2023, incorporated in the capitation rates through a separate payment term of up to $2.88 billion.
Approval Date:
October 27, 2023
Effective Date:
July 1, 2022
Links:
State Rating Period:
July 1, 2022
-
June 30, 2023
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
Virginia
The minimum fee schedule established by the state for Durable Medical Equipment providers for the rating period covering October 1, 2023 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
October 27, 2023
Effective Date:
October 1, 2023
Links:
State Rating Period:
October 1, 2023
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Other
Tennessee
Uniform dollar increase established by the state for eligible behavioral health inpatient and outpatient services at Comprehensive Child and Family Treatment agencies (CCFT) for the rating period covering January 1, 2023 through December 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
October 26, 2023
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
December 31, 2023
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Behavioral health inpatient service
Behavioral health outpatient services
Virginia
Uniform increase established by the state for physicians employed by or contracted with the non-state government owned general acute care academic medical center, for the rating period covering July 1, 2023 through September 30, 2023, incorporated in the capitation rates through a separate payment term of up to $432,500.
Approval Date:
October 26, 2023
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
September 30, 2023
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Other