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
Nevada
Value-based payment established by the state for free standing nursing facilities for the rating period January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term up to $13.2 million.
Approval Date:
August 28, 2024
Effective Date:
January 1, 2024
Links:
State Rating Period:
January 1, 2024
-
December 31, 2024
Payment Type:
Fee schedule
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Nursing facility services
New York
The value-based payment arrangement established by the state for Behavioral Health Independent Practice Associations delivering behavioral health outpatient and HCBS services for the rating period covering April 1, 2024 – March 31, 2025, incorporated into the capitation rates through a separate payment term of up to $10,000,000.
Approval Date:
August 28, 2024
Effective Date:
April 1, 2024
Links:
State Rating Period:
April 1, 2024
-
March 31, 2025
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Other
Rhode Island
Uniform increase established by the state for inpatient hospital services for the rating period covering July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
August 28, 2024
Effective Date:
July 1, 2024
Links:
State Rating Period:
July 1, 2024
-
June 30, 2025
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Virginia
Uniform increase for physician services provided by physicians who participate in Children’s Specialty Group, affiliated with Children’s Hospital of the King’s Daughters, for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $11,050,000.
Approval Date:
August 28, 2024
Effective Date:
July 1, 2024
Links:
State Rating Period:
July 1, 2024
-
June 30, 2025
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Specialty physician services
Ohio
The uniform percentage increase for participating health systems affiliated with a public medical school established by the state for qualified practitioners for the rating period January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a risk based adjustment and a separate payment term up to $1,000,000.
Approval Date:
August 27, 2024
Effective Date:
January 1, 2024
Links:
State Rating Period:
January 1, 2024
-
December 31, 2024
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Other
Primary care services
Professional services at an academic medical center
Specialty physician services
Ohio
The uniform percentage increase for participating health systems affiliated with a public medical school in Northeast class established by the state for qualified practitioners for the rating period January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a risk based adjustment and a separate payment term up to $3,385,000.
Approval Date:
August 27, 2024
Effective Date:
January 1, 2024
Links:
State Rating Period:
January 1, 2024
-
December 31, 2024
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Other
Primary care services
Professional services at an academic medical center
Specialty physician services
Massachusetts
The Hospital Quality Incentive proposal for the rating period covering April 1, 2023 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $75 million each year for 2023 and 2024 rating years.
Approval Date:
August 22, 2024
Effective Date:
April 1, 2022
Links:
State Rating Period:
April 1, 2022
-
December 31, 2022
Payment Type:
Value-based payment
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Outpatient hospital service
Rhode Island
Uniform increase established by the state for inpatient hospital services for the rating period covering July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
August 21, 2024
Effective Date:
July 1, 2024
Links:
State Rating Period:
July 1, 2024
-
June 30, 2025
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Massachusetts
The Hospital Quality Incentive proposal for the rating period covering April 1, 2023 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $87.5 million for April 1, 2023 through December 31, 2023 and $125 million for rating year 2024.
Approval Date:
August 20, 2024
Effective Date:
April 1, 2023
Links:
State Rating Period:
April 1, 2023
-
December 31, 2023
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
New York
Uniform increase for Government general hospitals as established by the state, other than those operated by the State of New York or the State University of New York, located in a city with a population of over one million, for outpatient hospital services for the rating period, April 1, 2023 through March 31, 2024, incorporated into the capitation rates through a separate payment term up to $900,800,521.
Approval Date:
August 20, 2024
Effective Date:
April 1, 2023
Links:
State Rating Period:
April 1, 2023
-
March 31, 2024
Payment Type:
Fee schedule
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Outpatient hospital service