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
New Mexico
Uniform increase for inpatient and outpatient hospital services and performance-based quality payments established by the state for hospitals that provide guaranteed access to care for Native Americans through the Indian Health Service for the rating period covering January 1, 2023 through December 31, 2023, incorporated into the capitation rates through a separate payment term of up to $133 million.
Approval Date:
October 5, 2023
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
December 31, 2023
Payment Type:
No state
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
New York
The uniform increase for Sole Community Hospitals established by the state for outpatient 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 $121,377,916.
Approval Date:
October 4, 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:
Outpatient hospital service
New York
The uniform increase for Critical Access Hospitals established by the state for outpatient 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 $49,576,895.
Approval Date:
October 4, 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:
Outpatient hospital service
Iowa
A uniform increase for physician and professional services at qualifying Iowa state-owned or operated professional services practices as defined in 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 $116,808,663.
Approval Date:
October 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:
Professional services at an academic medical center
Florida
Uniform percentage increase established by the state for primary care and specialty physician services at public hospitals for the rating period covering October 1, 2022 through September 30, 2023, incorporated into the capitation rates through a separate payment term of up to $80,051,380.
Approval Date:
September 28, 2023
Effective Date:
October 1, 2022
Links:
State Rating Period:
October 1, 2022
-
September 30, 2023
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Primary care services
Specialty physician services
Florida
Uniform percentage increase established by the state for eligible inpatient and outpatient hospital services for the rating period covering October 1, 2022 through September 30, 2023, incorporated in the capitation rates through a separate payment term of up to $3,430,910,455.
Approval Date:
September 28, 2023
Effective Date:
October 1, 2022
Links:
State Rating Period:
October 1, 2022
-
September 30, 2023
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
Illinois
Uniform increase established by the state for inpatient and outpatient services at large non-state government hospitals for the rating period covering January 1, 2023 through December 31, 2023 incorporated in the capitation rates through a separate payment term of up to $630,200,000.
Approval Date:
September 28, 2023
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
December 31, 2023
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
North Carolina
Uniform percentage increase established by the state for inpatient and outpatient hospital services and behavioral health inpatient and outpatient hospital services at eligible acute care and critical access 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 $2,596,485,198.
Approval Date:
September 28, 2023
Effective Date:
July 1, 2022
Links:
State Rating Period:
July 1, 2022
-
June 30, 2023
Payment Type:
Fee schedule
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Behavioral health inpatient service
Behavioral health outpatient services
Inpatient hospital service
Outpatient hospital service
Georgia
The GA-AIDE uniform increase and performance improvement initiative for inpatient and outpatient hospital services established by the state 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 $463,642,464.
Approval Date:
September 27, 2023
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
June 30, 2024
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
Georgia
The uniform percentage increase for inpatient and outpatient hospital services established by the state 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$295,260,164.
Approval Date:
September 25, 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
Outpatient hospital service