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
Wisconsin
Uniform percentage increase established by the state for eligible home and community-based services for the rating period, January 1, 2025 through December 31, 2025,incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
April 24, 2025
Effective Date:
January 1, 2025
Links:
Wisconsin
Uniform percentage increase established by the state for eligible home and community-based services for the rating period, January 1, 2025 through December 31, 2025,incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
April 24, 2025
Effective Date:
January 1, 2025
Links:
Michigan
Uniform dollar increase established by the state for professional services provided by practitioners employed or under contract with approved public entities for the rating period covering October 1, 2022 through September 30, 2023, and incorporated in the capitation rates through a separate payment term of up to $583,505,495.00.
Approval Date:
April 24, 2025
Effective Date:
October 1, 2022
Links:
Michigan
Uniform dollar increase for psychiatric inpatient days for the rating period covering October 1, 2021 through September 30, 2022, and incorporated in the capitation rates through a separate payment term of up to $99 million.
Approval Date:
April 23, 2025
Effective Date:
October 1, 2021
Links:
New Hampshire
Minimum fee schedule established by the state for durable medical equipment for the rating period covering July 1, 2025 through June 30, 2026, incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
April 18, 2025
Effective Date:
July 1, 2025
Links:
Arizona
Uniform increase provided by the eligible public safety net hospital established by the state for inpatient and outpatient hospital services for the rating period covering October 1, 2024 through September 30, 2025, incorporated into the capitation rate through a separate payment term of up to $388,500,819.
Approval Date:
April 15, 2025
Effective Date:
October 1, 2024
Links:
New Jersey
A pay-for-performance initiative focused on behavioral health performance improvement among acute care hospitals for the rating period covering July 1, 2025 through June 30, 2026, incorporated into the capitation rates through a separate payment term of up to $147,000,000.
Approval Date:
April 15, 2025
Effective Date:
July 1, 2025
Links:
Puerto Rico
Minimum fee schedule established by the state for specialty physician services and behavioral health outpatient services for the rating period, October 1, 2024 through September 30, 2025, incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
April 11, 2025
Effective Date:
October 1, 2024
Links:
New Jersey
A pay-for-performance initiative focused on maternal health performance improvement among acute care hospitals licensed to provide Labor and Delivery Services for the rating period covering July 1, 2025 through June 30, 2026, incorporated into the capitation rates through a separate payment term of up to $63,000,000.
Approval Date:
April 11, 2025
Effective Date:
July 1, 2025
Links:
Washington
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, 2023 through December 31, 2023, incorporated in the capitation rates through a separate payment term of up to $120,526,551.76.
Approval Date:
April 10, 2025
Effective Date:
January 1, 2023
Links: