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
Texas
Comprehensive Hospital Increase Reimbursement Program (CHIRP) 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:
September 13, 2024
Effective Date:
September 1, 2024
Links:
Massachusetts
The proposal requiring that Managed Care Organizations (MCO) share savings/losses with MCO-administered Accountable Care Organizations (ACO) for the rating period covering January 1, 2022 – December 31, 2022.
Approval Date:
September 11, 2024
Effective Date:
January 1, 2022
Links:
Massachusetts
The proposal requiring that Managed Care Organizations (MCO) share savings/losses with MCO-administered Accountable Care Organizations (ACO) for the rating period covering January 1, 2023 – March 31, 2023.
Approval Date:
September 11, 2024
Effective Date:
January 1, 2023
Links:
Rhode Island
Uniform increase established by the state for eligible outpatient hospital 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:
September 11, 2024
Effective Date:
July 1, 2024
Links:
Rhode Island
Uniform increase established by the state for eligible outpatient hospital 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:
September 11, 2024
Effective Date:
July 1, 2024
Links:
Vermont
Value based payment arrangement for Children’s Integrated Services (CIS) providers established by the state for the rating period January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
September 11, 2024
Effective Date:
January 1, 2024
Links:
Georgia
Uniform percentage increase for physician and other eligible professional services established by the state for the rating period covering July 1, 2021 through June 30, 2022, incorporated in the capitation rates through a separate payment term of up to $129,984,744.
Approval Date:
September 3, 2024
Effective Date:
July 1, 2021
Links:
Georgia
Uniform percentage increase for inpatient and outpatient hospital services established by the state for the rating period covering July 1, 2021 through June 30, 2022, incorporated in the capitation rates through a separate payment term of up to $234,676,123.
Approval Date:
September 3, 2024
Effective Date:
July 1, 2021
Links:
New Mexico
Renewal of a value-based purchasing and uniform percent increase arrangement established by the state to increase nursing facility per diem rates by the market basket index (MBI) factor and to provide quality incentive payments for nursing facilities that meet performance requirements on specified quality metrics for the rating period covering July 1, 2024 through December 31, 2024, incorporated into the capitation rates through a risk-based adjustment.
Approval Date:
September 3, 2024
Effective Date:
July 1, 2024
Links:
New Mexico
Renewal of the uniform percentage increase established by the state for qualified practitioners who are members of a practice plan under contract to provide professional services at a state-owned academic medical center for the rating period covering July 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $13 million.
Approval Date:
September 3, 2024
Effective Date:
July 1, 2024
Links: