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
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, 2023 – March 31, 2023.
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:
Inpatient hospital service
Massachusetts
Uniform increase established by the state for certain Home Health Aide, Homemaker, and Personal Care providers (excepting Personal Care providers providing services through the self-directed Personal Care Attendant Program) for the rating period covering January 1, 2022 through 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:
HCBS/personal care services
Texas
Behavioral Health Services (BHS) directed payment program 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:
July 30, 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
Iowa
A uniform increase for physician and professional services at qualifying Iowa state-owned or operated professional services practices as defined in the Medicaid State Plan for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $121,094,222.
Approval Date:
July 29, 2024
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Professional services at an academic medical center
Iowa
Uniform increase for inpatient and outpatient hospital services at qualifying Iowa state-owned or operated teaching hospitals as defined in the Medicaid State Plan for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $534,243,548.
Approval Date:
July 29, 2024
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
North Carolina
Uniform percentage increase established by the state for inpatient and outpatient hospital services for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $4,053,353,828.
Approval Date:
July 26, 2024
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Behavioral health inpatient service
Behavioral health outpatient services
Inpatient hospital service
Outpatient hospital service
North Carolina
Uniform percentage increase established by the state for inpatient and outpatient hospital 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 $6,288,572,664.
Approval Date:
July 26, 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:
Behavioral health inpatient service
Behavioral health outpatient services
Inpatient hospital service
Outpatient hospital service
New Mexico
The uniform dollar increase established by the state for inpatient and outpatient hospital services for hospitals in rural or underserved communities with active maternal/obstetric programs for the rating period January 1, 2024 through June 30, 2024, incorporated into the capitation rates through a separate payment term up to $10,936,000.
Approval Date:
July 26, 2024
Effective Date:
January 1, 2024
Links:
State Rating Period:
January 1, 2024
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
California
Quality Incentive Pool for Designated 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 $2,037,470,000.
Approval Date:
July 24, 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
Rhode Island
Uniform increase for all contracted home care agencies providing homemaker and CAN services for the rating period covering July 1, 2023 through June 30, 2024, incorporated into the capitation rates through a risk-based rate adjustment or through a separate payment term up to $3,750,000.
Approval Date:
July 23, 2024
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
HCBS/personal care services