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
Mississippi
Uniform percentage increase established by the state for inpatient and outpatient hospital services for the rating period covering July 1, 2021 through June 30, 2022, incorporated in the capitation rates through a separate payment term of up to $533,110,956.00.
Approval Date:
June 5, 2023
Effective Date:
July 1, 2021
Links:
State Rating Period:
July 1, 2021
-
June 30, 2022
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
Mississippi
Uniform percentage increase established by the state for inpatient and outpatient hospital services 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 $601,153,602.00.
Approval Date:
June 1, 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
California
Uniform dollar increases established by the state for specific services provided by network physicians 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:
May 26, 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:
Behavioral health outpatient services
Primary care services
Specialty physician services
West Virginia
The Uniform Increase for eligible Acute Care Hospitals established by the state for Inpatient, Outpatient, and Physician Services 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 $343,997,344.
Approval Date:
May 22, 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
Primary care services
Professional services at an academic medical center
Illinois
Uniform increase established by the state for services provided by physicians employed by State-owned medical schools 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 $145,400,000.
Approval Date:
May 19, 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:
Professional services at an academic medical center
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, 2022 through December 31, 2022, incorporated in the capitation rates through a separate payment term of up to $396,200,000.
Approval Date:
May 19, 2023
Effective Date:
January 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:
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, 2022 through March 31, 2023, incorporated in the capitation rates through a separate payment term of up to $107,280,220.
Approval Date:
May 19, 2023
Effective Date:
April 1, 2022
Links:
State Rating Period:
April 1, 2022
-
March 31, 2023
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, 2022 through March 31, 2023, incorporated in the capitation rates through a separate payment term of up to $43,818,681.
Approval Date:
May 19, 2023
Effective Date:
April 1, 2022
Links:
State Rating Period:
April 1, 2022
-
March 31, 2023
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Outpatient hospital service
North Carolina
Uniform dollar increase for home and community-based services and behavioral health outpatient services established by the state 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:
May 9, 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:
Behavioral health outpatient services
HCBS/personal care services
New York
The enhanced minimum fee schedule for home and community-based services approved through the state’s 1115 waiver for the rating period covering April 1, 2022 through March 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
May 9, 2023
Effective Date:
April 1, 2022
Links:
State Rating Period:
April 1, 2022
-
March 31, 2023
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
HCBS/personal care services