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
Louisiana
A uniform dollar increase for psychotherapy services that utilize dialectical behavior therapy (DBT) for behavioral health outpatient 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 $172,000.
Approval Date:
March 24, 2025
Effective Date:
January 1, 2025
Links:
Arizona
Uniform increase for inpatient and outpatient hospital services at freestanding children’s hospitals with more than 100 licensed pediatric beds for the rating period covering October 1, 2024 through September 30, 2025, and incorporated in the capitation rates through a separate payment term of up to $59,120,000.
Approval Date:
March 20, 2025
Effective Date:
October 1, 2024
Links:
Wisconsin
Minimum and maximum fee schedules established by the state for the rating period, January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
March 20, 2025
Effective Date:
January 1, 2025
Links:
Louisiana
Uniform increase for licensed mental health providers, and certain provisionally licensed mental health providers, who perform specific services for the rating period covering July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $18,400,000.
Approval Date:
March 19, 2025
Effective Date:
July 1, 2024
Links:
Puerto Rico
Minimum fee schedule established by the state for dental 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:
March 18, 2025
Effective Date:
October 1, 2024
Links:
Kansas
Uniform percentage increase for inpatient and outpatient hospital services provided by eligible general hospitals, for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $41,000,000.
Approval Date:
March 12, 2025
Effective Date:
January 1, 2024
Links:
Pennsylvania
Value-based purchasing established by the state for eligible nursing facility services for the rating period, January 1, 2023 through December 31, 2023, incorporated into the capitation rates through a separate payment term up to $15,000,000.
Approval Date:
March 12, 2025
Effective Date:
January 1, 2023
Links:
Tennessee
Uniform dollar increase established by the state for emergency ground ambulance services for the rating period, January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term up to $36,579,920.
Approval Date:
March 12, 2025
Effective Date:
January 1, 2025
Links:
Massachusetts
Uniform increase established by the state for eligible inpatient hospital services for the rating period covering January 1, 2023 through December 31, 2023, incorporated into the capitation rates for the Managed Behavioral Health Vendor through a separate payment term of up to $4,601,248.
Approval Date:
March 4, 2025
Effective Date:
January 1, 2023
Links:
New Hampshire
The value-based payment for eligible community mental health centers established by the state for behavioral health outpatient services for the rating period September 1, 2024through June 30, 2025, incorporated into the capitation rates through a risk-based rate adjustment up to $5,000,000.
Approval Date:
February 21, 2025
Effective Date:
September 1, 2024
Links: