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 York
The enhanced minimum fee schedule for home and community-based services approved through the state’s 1115 waiver for the rating period, April 1, 2023 through March 31, 2024, incorporated into the capitation rates through a risk-based rate adjustment.
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:
Renewal
Approval Period:
Single Rating Period
Provider Class:
HCBS/personal care services
Rhode Island
Uniform increase established by the state for eligible inpatient and outpatient hospital services, for the rating period July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term of up to $281,032,815.
Approval Date:
August 20, 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
Outpatient hospital service
Rhode Island
Uniform increase established by the state for personal care and combined personal care/homemaker 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 19, 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:
HCBS/personal care services
Texas
Rural Access to Primary and Preventative Services (RAPPS) for the rating period covering September 1, 2024 through August 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
August 15, 2024
Effective Date:
September 1, 2024
Links:
State Rating Period:
September 1, 2024
-
August 31, 2025
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Other
Texas
Quality Improvement Payment Program (QIPP) for the rating period covering September 1, 2024 through August 31, 2027, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
August 14, 2024
Effective Date:
September 1, 2024
Links:
State Rating Period:
September 1, 2024
-
August 31, 2027
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Multiple Rating Period
Provider Class:
Other
Puerto Rico
Minimum fee schedule established by the state for primary care services and laboratory services that are covered at 75% of Medicare consistent with the requirements of the Consolidated Appropriations Act of 2023 for the rating period covering October 1, 2023through September 30, 2024 incorporated in the capitation rates through a risk-based adjustment.
Approval Date:
August 13, 2024
Effective Date:
October 1, 2023
Links:
State Rating Period:
October 1, 2023
-
September 30, 2024
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Primary care services
Rhode Island
Uniform increase established by the state for personal care and combined personal care/homemaker 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 8, 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:
HCBS/personal care services
California
Quality Incentive Pool for District and Municipal Public Hospital Systems for the rating period of January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $172,099,711.
Approval Date:
August 5, 2024
Effective Date:
January 1, 2024
Links:
State Rating Period:
January 1, 2024
-
December 31, 2024
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
Massachusetts
Minimum Fee Schedule and Maximum Fee Schedule for inpatient hospital discharges from freestanding pediatric hospitals with a MassHealth DRG weight of 3.0 or greater and hospitals with a pediatric specialty unit with a MassHealth DRG weight of 3.0 or greater, using an approved State plan fee schedule for the rating period covering January1, 2022 – December 31, 2022.
Approval Date:
August 2, 2024
Effective Date:
January 1, 2022
Links:
State Rating Period:
January 1, 2022
-
March 31, 2022
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
Massachusetts
Minimum fee scheduled established by the State for outpatient behavioral health services and behavioral health diversionary services 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:
August 2, 2024
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
March 31, 2023
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Behavioral health outpatient services
Other