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
North Carolina
Minimum fee schedule established by the state for local health department services for rating periods covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term amount of up to $82,900,000.
Approval Date:
July 1, 2025
Effective Date:
July 1, 2025
Links:
Michigan
Uniform dollar increase for nursing facility services 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 $34,148,153.
Approval Date:
July 1, 2025
Effective Date:
January 1, 2025
Links:
New Hampshire
Uniform dollar increase for children’s inpatient and outpatient services with recognized children’s hospitals established by the state for rating periods covering July 1, 2025through June 30, 2026, incorporated in the capitation rates through a separate payment term amount of up to $1,309,591.
Approval Date:
July 1, 2025
Effective Date:
July 1, 2025
Links:
New Mexico
A uniform increase for primary care services for the rating period covering July 1, 2024through December 31, 2024, incorporated in the capitation rates through a separate payment term amount of up to $7 million.
Approval Date:
July 1, 2025
Effective Date:
July 1, 2024
Links:
Virginia
Uniformed percentage increase for physicians employed by or contracted with a private acute care type 2 hospital system with at least on level 2 trauma center as of January 2022 with at least 290 beds in cost report period 2020 located in the Eastern Health Planning Region, for the rating period, July 1, 2025 through June 30, 2026, incorporated into the capitation rates through a separate payment term up to $8,567,924.00.
Approval Date:
July 1, 2025
Effective Date:
July 1, 2025
Links:
Virginia
Uniform percentage increase for physician services by physicians employed by or contracted with an acute care hospital chain with a level one trauma center in the Tidewater Metropolitan Statistical Area (MSA) in 2020, for rating period July 1, 2025through June 30, 2026, incorporated in the capitation rates through a separate payment term amount of up to $21,048,306.
Approval Date:
July 1, 2025
Effective Date:
July 1, 2025
Links:
Oregon
Uniform dollar increase for dental services for the rating period covering January 1,2025 through December 31, 2025, incorporated in the capitation rates through a risk-based adjustment.
Approval Date:
July 1, 2025
Effective Date:
January 1, 2025
Links:
Oregon
Value based payments for dental providers for the rating period covering January 1,2025 through December 31, 2025, incorporated in the capitation rates through a risk-based adjustment.
Approval Date:
July 1, 2025
Effective Date:
January 1, 2025
Links:
Oregon
Value based payments for dental providers for the rating period covering January 1,2025 through December 31, 2025, incorporated in the capitation rates through a risk-based adjustment.
Approval Date:
July 1, 2025
Effective Date:
January 1, 2025
Links:
New Mexico
Renewal of the uniform percentage increase established by the state for qualified practitioners who are members of a practice plan under contract to provide professional services at a state-owned academic medical center for the rating period covering January1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $34 million.
Approval Date:
July 1, 2025
Effective Date:
January 1, 0025
Links: