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
Illinois
The uniform increase for long term acute care hospitals established by the state for inpatient hospital services for the rating period, January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $1,750,000.
Approval Date:
January 10, 2025
Effective Date:
October 1, 2024
Links:
Iowa
Uniform increase for physician and professional services provided at qualifying Iowa state-owned or operated professional services practices for the rating period covering July 1, 2022 through June 30, 2023, incorporated into the capitation rates through a separate payment term up to $113,808,126.
Approval Date:
January 8, 2025
Effective Date:
July 1, 2022
Links:
Iowa
Uniform increase for inpatient and outpatient hospital services at qualifying Iowa state owned or operated teaching hospitals for the rating period covering July 1, 2022 through June 30, 2023, incorporated into the capitation rates through a separate payment term up to $481,979,441.
Approval Date:
January 8, 2025
Effective Date:
July 1, 2022
Links:
Wisconsin
Uniform percentage increase established by the state for eligible home and community-based services for the rating period, January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term of up to $151,000,000.
Approval Date:
January 8, 2025
Effective Date:
January 1, 2024
Links:
Utah
An alternative fee schedule established by the state for behavioral health outpatient services for the rating period covering July 1, 2024 through June 30, 2025, incorporated in the capitation rates through a risk-based adjustment.
Approval Date:
January 7, 2025
Effective Date:
July 1, 2024
Links:
Oklahoma
Uniform increase for inpatient and outpatient hospital services at private, non-state government, and critical access hospitals for the rating period covering April 1, 2024 through June 30, 2025 incorporated in the capitation rates through a separate payment term of up to $1,262,703,035.
Approval Date:
December 30, 2024
Effective Date:
April 1, 2024
Links:
Mississippi
Uniform percentage increase and performance improvement initiative established by the state for professional services at an academic medical center for the rating period covering July 1, 2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term of up to $29,526,177.
Approval Date:
December 23, 2024
Effective Date:
July 1, 2024
Links:
Oregon
Uniform dollar increase for inpatient and outpatient hospital services established by the state 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 $9,500,000.
Approval Date:
December 19, 2024
Effective Date:
January 1, 2024
Links:
Oregon
Uniform dollar increase for inpatient and outpatient hospital services, established by the state 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 $45,410,000.
Approval Date:
December 18, 2024
Effective Date:
January 1, 2024
Links:
Massachusetts
Continuous Quality Improvement (CQI) value-based payment arrangement established by the state for private acute hospitals for the rating period covering April 1, 2023 through December 31, 2024, incorporated into the capitation rates through a separate payment term of up to $104,200,00 for April 1, 2023 to December 31, 2023 and up to $147,000,000 for January 1, 2024 to December 31, 2024.
Approval Date:
December 17, 2024
Effective Date:
April 1, 2023
Links: