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 uniform dollar increase for acute care hospitals established by the state for outpatient hospital services for the rating period July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $543,923,045.
Approval Date:
November 6, 2024
Effective Date:
July 1, 2024
Links:
New Jersey
A perinatal episode of care pilot established by the state for the rating period covering July 1, 2024 through June 30, 2025 incorporated into the capitation rates through a risk based rate adjustment and separate payment term of up to $3.5 million.
Approval Date:
November 6, 2024
Effective Date:
July 1, 2024
Links:
Missouri
Uniform percentage increases for the professional services of designated providers affiliated with one of the qualifying hospitals 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 $42,885,009.17.
Approval Date:
October 29, 2024
Effective Date:
July 1, 2024
Links:
Virginia
The quality payment established by the state for nursing facility 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 $184.9 million.
Approval Date:
October 29, 2024
Effective Date:
July 1, 2024
Links:
North Carolina
Uniform dollar increase established by the state for inpatient and outpatient hospital services at ECU Health Medical Center for the rating period covering July 1, 2024through June 30, 2025, incorporated in the capitation rates through a separate payment term of up to $71,730,243.
Approval Date:
October 24, 2024
Effective Date:
July 1, 2024
Links:
North Carolina
Uniform dollar increase established by the state for inpatient and outpatient hospital services at UNC Health Care System hospitals for the rating period covering July 1, 2024through June 30, 2025, incorporated in the capitation rates through a separate payment term of up to $134,409,751.
Approval Date:
October 24, 2024
Effective Date:
July 1, 2024
Links:
Iowa
Uniform increase established by the state for eligible ground emergency medical, transportation providers for the rating period covering July 1, 2024 through June 30, 2025, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
October 1, 2024
Effective Date:
July 1, 2024
Links:
Illinois
Value based payment arrangement established by the state for eligible primary care and behavioral health providers contracted with the Egyptian Health Department for the rating periods covering January 1, 2024 through December 31, 2024.
Approval Date:
October 1, 2024
Effective Date:
January 1, 2024
Links:
Missouri
Minimum fee schedule for Community Mental Health Clinics established by the state for the rating period covering July 1, 2024 through June 30, 2025, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
October 1, 2024
Effective Date:
July 1, 2024
Links:
Rhode Island
Uniform increase established by the state for shared living services for the rating period July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a risk based rate adjustment.
Approval Date:
October 1, 2024
Effective Date:
July 1, 2024
Links: