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
Oklahoma
Uniform increase for physicians and other qualifying practitioners established by the state for the purpose of using funds generated by the Supplemental Hospital Offset Payment Program (SHOPP) fee which establishes a managed care provider incentive pool to support healthcare quality assurance and access improvement initiatives, 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 $115,694,212.
Approval Date:
June 2, 2026
Effective Date:
July 1, 2025
Links:
New Jersey
Uniform dollar increase for inpatient and outpatient hospital services provided by Monmouth County 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 $393,023,133.
Approval Date:
June 2, 2026
Effective Date:
July 1, 2025
Links:
New Jersey
Uniform increase for inpatient and outpatient hospital services provided by Burlington County 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 $161,590,174.
Approval Date:
June 2, 2026
Effective Date:
July 1, 2025
Links:
New Jersey
Uniform increase for inpatient and outpatient hospital services provided by Atlantic County 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 $166,050,629.
Approval Date:
June 2, 2026
Effective Date:
July 1, 2025
Links:
New Jersey
Uniform increase for inpatient and outpatient hospital services provided by Essex County 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 $566,687,809.
Approval Date:
June 2, 2026
Effective Date:
July 1, 2025
Links:
New Jersey
Uniform increase for inpatient hospital services provided by Cumberland County hospitals for the rating period covering July1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term amount of up to $90,779,944.
Approval Date:
June 2, 2026
Effective Date:
July 1, 2025
Links:
New Jersey
Uniform increase for inpatient hospital services provided by Passaic County 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 $145,767,110.
Approval Date:
June 2, 2026
Effective Date:
July 1, 2025
Links:
New Jersey
Uniform increase for inpatient hospital services provided by Hudson County 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 $198,272,741.
Approval Date:
June 2, 2026
Effective Date:
July 1, 2025
Links:
Pennsylvania
Minimum Fee Schedule for nursing facility services for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment of up to $1,850,000,000.
Approval Date:
June 2, 2026
Effective Date:
January 1, 2026
Links:
New Hampshire
Uniform dollar increase for qualified behavioral health outpatient services established by the state for the rating period covering July 1, 2026 through June 30, 2027, incorporated in the capitation rates through a separate payment term amount up to $2,650,000.
Approval Date:
May 28, 2026
Effective Date:
July 1, 2026
Links: