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
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) for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
November 13, 2024
Effective Date:
January 1, 2024
Links:
Arizona
The Targeted Investment program for Primary Care Providers established by the state for the rating period covering October 1, 2021 through September 30, 2022 incorporated in the capitation rates through a separate payment term of up to $21.7 million.
Approval Date:
November 12, 2024
Effective Date:
October 1, 2021
Links:
Arizona
The Targeted Investment program established by the state for behavioral health outpatient ambulatory focus areas 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 $23.8 million.
Approval Date:
November 12, 2024
Effective Date:
October 1, 2022
Links:
Nevada
Uniform increase for eligible inpatient and outpatient services at eligible private hospitals for the rating period January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term up to $892,212,397.
Approval Date:
November 9, 2024
Effective Date:
January 1, 2024
Links:
Florida
Uniform dollar increase established by the state for primary care services and pediatric nursing facility services for the rating period, October 1, 2023, through September 30,2024, incorporated into the capitation rates through a separate payment term of up to $15million.
Approval Date:
November 8, 2024
Effective Date:
October 1, 2023
Links:
North Carolina
Uniform dollar increase established by the state for the professional services at academic medical centers 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$103,203,351.
Approval Date:
November 8, 2024
Effective Date:
July 1, 2024
Links:
North Carolina
Minimum fee schedule established by the state for laboratory services provided by in-state acute care hospitals and critical access hospitals for the rating period covering July1, 2024 through June 30, 2025, incorporated in the capitation rates through a risk-based adjustment.
Approval Date:
November 8, 2024
Effective Date:
July 1, 2024
Links:
North Carolina
Minimum fee schedule established by the state for public ambulance provider 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:
November 8, 2024
Effective Date:
July 1, 2024
Links:
North Carolina
Uniform dollar increase established by the state for local health department services 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 $79,100,000.
Approval Date:
November 8, 2024
Effective Date:
July 1, 2024
Links:
Louisiana
Uniform increase for in-state providers of inpatient and outpatient hospital services, excluding freestanding psychiatric hospitals, freestanding rehabilitation hospitals, and long-term acute care hospitals for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to$2,806,800,000.
Approval Date:
November 7, 2024
Effective Date:
July 1, 2024
Links: