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Approved State Directed Payment Preprints

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.

Results

Displaying 11 - 20 of 836

Illinois

Uniform increase established by the state for inpatient and outpatient services at eligible Illinois hospitals for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $8,000,000,000.

Approval Date: September 9, 2025
Effective Date: January 1, 2025
State Rating Period: January 1, 2025 - December 31, 2025
Payment Type: Fee schedule
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Inpatient hospital service Outpatient hospital service

New Hampshire

The uniform dollar increase for inpatient discharges and outpatient visits to qualifying critical access hospitals for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term amount of up to $94,725,164.

Approval Date: September 9, 2025
Effective Date: July 1, 2025
State Rating Period: July 1, 2025 - June 30, 2026
Payment Type: No state
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Inpatient hospital service Outpatient hospital service

New York

Uniform increase for Sole Community Hospitals as established by the state for outpatient services for the rating period, April 1, 2025 through March 31, 2026, incorporated into the capitation rates through a separate payment term up to $145,653,499.

Approval Date: September 9, 2025
Effective Date: April 1, 2025
State Rating Period: April 1, 2025 - March 31, 2026
Payment Type: Fee schedule
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Outpatient hospital service

Washington

Uniform increase established by the state for qualified licensed professionals employed by a state university owned or operated hospital or affiliated practice, state owned and operated school of dentistry, or public hospital district for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $132,480,000.

Approval Date: September 9, 2025
Effective Date: January 1, 2025
State Rating Period: January 1, 2025 - December 31, 2025
Payment Type: Fee schedule
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Dental services Other Primary care services Professional services at an academic medical center Specialty physician services

Oregon

Uniform increase established by the state for inpatient and outpatient hospital services provided by Diagnosis-Related Group (DRG) hospitals for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $1,011,000,000.

Approval Date: September 9, 2025
Effective Date: January 1, 2025
State Rating Period: January 1, 2025 - December 31, 2025
Payment Type: Fee schedule
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Inpatient hospital service Outpatient hospital service

Kansas

Uniform increase for inpatient and outpatient hospital services for critical access hospitals and general hospitals for rating period January 1, 2025, through December 31,2025, incorporated in the capitation rates through separate payment term of up to $998,000,000.

Approval Date: September 9, 2025
Effective Date: January 1, 2025
State Rating Period: January 1, 2025 - December 31, 2025
Payment Type: Fee schedule
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Inpatient hospital service Outpatient hospital service

Massachusetts

Uniform increase established by the state for eligible inpatient and outpatient hospital services for the rating period covering January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term of up to $600,000,000.

Approval Date: September 9, 2025
Effective Date: January 1, 2024
State Rating Period: January 1, 2024 - December 31, 2024
Payment Type: Fee schedule
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Inpatient hospital service Outpatient hospital service

Virginia

Uniform increase for inpatient and outpatient services rendered by non-state government owned acute care hospitals for the rating period covering July 1, 2025, through June 30, 2026, incorporated in the capitation rates through a separate payment term of up to $74,610,061.

Approval Date: September 9, 2025
Effective Date: July 1, 2025
State Rating Period: July 1, 2025 - June 30, 2026
Payment Type: Fee schedule
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Inpatient hospital service Outpatient hospital service

Virginia

Uniform percentage increase for physician services by physicians employed by or contracted with a private acute care type 2 hospital system with at least one level 2trauma center as of January 2022 located in Lord Fairfax Health District and Northwest Health Planning Region, for the rating period, July 1, 2025 through June 30, 2026,incorporated in to the capitation rates through a separate payment term of up to$5,098,995.

Approval Date: September 9, 2025
Effective Date: July 1, 2025
State Rating Period: July 1, 2025 - June 30, 2026
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

Oregon

Uniform increase established by the state for inpatient and outpatient hospital services provided by Rural Type A/B hospitals for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $190,000,000.

Approval Date: September 9, 2025
Effective Date: January 1, 2025
State Rating Period: January 1, 2025 - December 31, 2025
Payment Type: Fee schedule
Review Type: Renewal
Approval Period: Single Rating Period
Provider Class: Inpatient hospital service Outpatient hospital service