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
Uniform percentage increase for professional services at an academic medical center for rating periods covering July 1, 2026 through June 30, 2027, incorporated in the capitation rates through a separate payment term amount up to $31,002,486.
Uniform increase for inpatient and outpatient hospital services for the Safety Net Services Initiative for the rating period covering October 1, 2026 through September 30, 2027, incorporated in the capitation rates through a separate payment term amount up to $521.99 million.
Uniform increase for inpatient and outpatient hospital services for the pediatric services initiative for the rating period covering October 1, 2026 through September 30, 2027, incorporated in the capitation rates through a separate payment term amount up to $104,870,000.
Uniform percentage increase for hospitals owned and operated by or operated by a state university established by the state for inpatient and outpatient hospital services for the rating period, January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $552,000,000.
A uniform increase established by the state for qualified licensed professionals employed by the University of Washington and/or a member of its affiliated physician practice plans or employed by a public hospital or other public entity for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term up to $126,280,000.
Minimum Fee Schedule for professional services at an academic medical center for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a risk-based rate adjustment up to $56,478,910.
Uniform percentage increase for eligible governmental ground ambulance transportation providers established by the state for the rating period, July 1, 2025 through June 30, 2026, incorporated into the capitation rates through a separate payment term up to $19,389,251.
Uniform increase for inpatient hospital services and outpatient hospital services for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term amount up to $466,566,350.
Uniform Increase for professional services at an academic medical center for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term amount up to $45,366,274.
Uniform increases established by the state for eligible Designated Public Hospital systems for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term amount up to $3,865,000,000.