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
Renewal of the uniform dollar increase for inpatient and outpatient hospital services and performance-based quality payments established by the state for the State Teaching Hospital that provides guaranteed access to care for Native Americans for the rating period covering January 1, 2024 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $155 million.
Uniform percentage increase established by the state for nursing facility services for the rating period, January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $89,005,752.
Uniform percentage increase established by the state for eligible inpatient and outpatient hospital services, excluding cancer hospitals, for the rating period, October 1, 2023 through September 30, 2024, incorporated into the capitation rates through a separate payment term up to $3,362,969,548.
Uniform increase for Sole Community Hospitals as established by the state for outpatient services for the rating period, April 1, 2024 through March 31, 2025, incorporated into the capitation rates through a separate payment term up to $121,377,916.
Uniform increase for Critical Access Hospitals as established by the state for outpatient services for the rating period, April 1, 2024 through March 31, 2025, incorporated into the capitation rates through a separate payment term up to $49,576,895.
The Hospital Quality Incentive proposal for the rating period covering January 1, 2023 through March 31, 2023, incorporated in the capitation rates through a separate payment term of up to $37.5 million.
Uniform increase established by the state for eligible home and community-based service (HCBS) providers for the rating period covering April 1, 2023 through December 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.
Uniform increase established by the state for eligible home and community-based service (HCBS) providers for the rating period covering January 1, 2023 through December 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.
Uniform percentage increase and performance improvement initiative payments 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 $1,565,840,324.
Minimum fee schedules established by the state for eligible primary care providers who have active New York State Patient Centered Medical Home (PCMH) recognition for assigned members for the rating period, April 1, 2024 through March 31, 2025, incorporated into the capitation rates through a separate payment term up to $203,730,871.