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
New Jersey
A minimum and maximum fee schedule for qualifying out-of-state pediatric hospital inpatient services established by the state for the rating period July 1, 2023 through June 30, 2024, incorporated into the capitation rates through a risk based rate adjustment, and through a separate payment term up to $2,705,308.
Approval Date:
July 15, 2024
Effective Date:
July 1, 2023
Links:
Louisiana
Uniform dollar increase for pediatric home health nurses established by the state for
home health services for the rating period, July 1, 2023 through June 30, 2024,
incorporated into the capitation rates through a separate payment term up to $3,307,280.
Approval Date:
March 22, 2024
Effective Date:
January 1, 2024
Links:
Rhode Island
The value-based payment Patient Centered Medical Home (PCMH)-Kids initiative established by the state for eligible pediatric providers for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
January 3, 2024
Effective Date:
July 1, 2023
Links:
Massachusetts
Maximum Fee Schedule for MassHealth contracted acute hospitals (except for specialty cancer hospitals, freestanding pediatric hospitals for an inpatient discharge with a MassHealth DRG Weight of 3 or greater, and the acute hospital with a pediatric specialty unit for enrollees under the age of 21 at the time of admission for an inpatient discharge with a MassHealth DRG Weight of 3 or greater) for the rating period covering January 1, 2022 through December 31, 2022, incorporated in the capitation rates through a risk- based rate adjustment.
Approval Date:
December 29, 2023
Effective Date:
January 1, 2022
Links:
Massachusetts
Maximum Fee Schedule for MassHealth contracted acute hospitals (except for specialty cancer hospitals, freestanding pediatric hospitals for an inpatient discharge with a MassHealth DRG Weight of 3 or greater, and the acute hospital with a pediatric specialty unit for enrollees under the age of 21 at the time of admission for an inpatient discharge with a MassHealth DRG Weight of 3 or greater) for the rating period covering January 1, 2023 through March 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
December 29, 2023
Effective Date:
January 1, 2023
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, 2023 through September 30, 2024, and incorporated in the capitation rates through a separate payment term of up to $71,331,662.
Approval Date:
December 12, 2023
Effective Date:
October 1, 2023
Links:
Rhode Island
The value-based payment Patient Centered Medical Home (PCMH)-Kids initiative established by the state for eligible pediatric providers for the rating period covering July 1, 2022 through June 30, 2023, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
June 20, 2023
Effective Date:
July 1, 2022
Links: