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 Mexico
Renewal of the value-based payment and uniform increase established by the state for participating nursing facilities that demonstrate quality improvement for the rating period covering July 1, 2024 through December 31, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
September 3, 2024
Effective Date:
July 1, 2024
Links:
Rhode Island
Uniform increase established by the state for nursing facility 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:
September 3, 2024
Effective Date:
July 1, 2024
Links:
Rhode Island
Uniform increase established by the state for nursing facility 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:
September 3, 2024
Effective Date:
October 1, 2024
Links:
Wisconsin
Uniform increase established by the state for inpatient and outpatient hospital service sand long-term acute care (LTAC) services at eligible critical access hospitals, acute, and rehabilitation hospitals for the rating period, January 1, 2024 through December 31,2024, incorporated into the capitation rates through a separate payment term of up to$510,504,611.
Approval Date:
September 3, 2024
Effective Date:
January 1, 2024
Links:
Nevada
Value-based payment established by the state for free standing nursing facilities for the rating period January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term up to $13.2 million.
Approval Date:
August 28, 2024
Effective Date:
January 1, 2024
Links:
New York
The value-based payment arrangement established by the state for Behavioral Health Independent Practice Associations delivering behavioral health outpatient and HCBS services for the rating period covering April 1, 2024 – March 31, 2025, incorporated into the capitation rates through a separate payment term of up to $10,000,000.
Approval Date:
August 28, 2024
Effective Date:
April 1, 2024
Links:
Rhode Island
Uniform increase established by the state for inpatient hospital 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 28, 2024
Effective Date:
July 1, 2024
Links:
Virginia
Uniform increase for physician services provided by physicians who participate in Children’s Specialty Group, affiliated with Children’s Hospital of the King’s Daughters, for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $11,050,000.
Approval Date:
August 28, 2024
Effective Date:
July 1, 2024
Links:
Ohio
The uniform percentage increase for participating health systems affiliated with a public medical school established by the state for qualified practitioners for the rating period January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a risk based adjustment and a separate payment term up to $1,000,000.
Approval Date:
August 27, 2024
Effective Date:
January 1, 2024
Links:
Ohio
The uniform percentage increase for participating health systems affiliated with a public medical school in Northeast class established by the state for qualified practitioners for the rating period January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a risk based adjustment and a separate payment term up to $3,385,000.
Approval Date:
August 27, 2024
Effective Date:
January 1, 2024
Links: