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
The Hospital Quality Incentive proposal for the rating period covering April 1, 2023 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $75 million each year for 2023 and 2024 rating years.
Approval Date:
August 22, 2024
Effective Date:
April 1, 2022
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 21, 2024
Effective Date:
July 1, 2024
Links:
Massachusetts
The Hospital Quality Incentive proposal for the rating period covering April 1, 2023 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $87.5 million for April 1, 2023 through December 31, 2023 and $125 million for rating year 2024.
Approval Date:
August 20, 2024
Effective Date:
April 1, 2023
Links:
New York
Uniform increase for Government general hospitals as established by the state, other than those operated by the State of New York or the State University of New York, located in a city with a population of over one million, for outpatient hospital services for the rating period, April 1, 2023 through March 31, 2024, incorporated into the capitation rates through a separate payment term up to $900,800,521.
Approval Date:
August 20, 2024
Effective Date:
April 1, 2023
Links:
New York
The enhanced minimum fee schedule for home and community-based services approved through the state’s 1115 waiver for the rating period, April 1, 2023 through March 31, 2024, incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
August 20, 2024
Effective Date:
April 1, 2023
Links:
Rhode Island
Uniform increase established by the state for eligible inpatient and outpatient hospital services, for the rating period July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term of up to $281,032,815.
Approval Date:
August 20, 2024
Effective Date:
July 1, 2024
Links:
Rhode Island
Uniform increase established by the state for personal care and combined personal care/homemaker 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 19, 2024
Effective Date:
July 1, 2024
Links:
Texas
Rural Access to Primary and Preventative Services (RAPPS) 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:
August 15, 2024
Effective Date:
September 1, 2024
Links:
Texas
Quality Improvement Payment Program (QIPP) for the rating period covering September 1, 2024 through August 31, 2027, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
August 14, 2024
Effective Date:
September 1, 2024
Links:
Puerto Rico
Minimum fee schedule established by the state for primary care services and laboratory services that are covered at 75% of Medicare consistent with the requirements of the Consolidated Appropriations Act of 2023 for the rating period covering October 1, 2023through September 30, 2024 incorporated in the capitation rates through a risk-based adjustment.
Approval Date:
August 13, 2024
Effective Date:
October 1, 2023
Links: