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
Uniform dollar increase for inpatient hospital and behavioral health inpatient services provided by Camden County hospitals for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $230,048,387.
Approval Date:
May 28, 2024
Effective Date:
July 1, 2024
Links:
State Rating Period:
July 1, 2024
-
June 30, 2025
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Behavioral health inpatient service
Inpatient hospital service
New Jersey
Minimum fee schedules as established by the state for professional services provided by qualified providers affiliated with schools of medicine or dentistry who participate in the New Jersey Medicaid program for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a risk-based rate adjustment
Approval Date:
May 23, 2024
Effective Date:
July 1, 2024
Links:
State Rating Period:
July 1, 2024
-
June 30, 2025
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Dental services
Primary care services
Professional services at an academic medical center
Specialty physician services
Utah
Uniform dollar increase for private inpatient hospital services for the rating period covering July 1, 2022 through June 30, 2023, incorporated in the capitation rates through a separate payment term of up to $154,000,000.
Approval Date:
May 22, 2024
Effective Date:
July 1, 2022
Links:
State Rating Period:
July 1, 2022
-
June 30, 2023
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Utah
A uniform percent increase for home and community based services providers, behavioral health providers, and school based services providers for the rating period covering July 1, 2022 through June 30, 2023, incorporated in the capitation rates through a separate payment term of up to $9,824,743.
Approval Date:
May 22, 2024
Effective Date:
July 1, 2022
Links:
State Rating Period:
July 1, 2022
-
June 30, 2023
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Behavioral health inpatient service
Behavioral health outpatient services
HCBS/personal care services
Vermont
The Value Based Payment for community mental health centers to deliver a continuum
of mental health services to adults and children via monthly case rates established by the
state for the rating period, January 1, 2023 through December 31, 2023, incorporated
into the capitation rates through a risk-based rate adjustment.
Approval Date:
May 21, 2024
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
December 31, 2023
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
HCBS/personal care services
Other
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 $144.1 million.
Approval Date:
May 20, 2024
Effective Date:
July 1, 2024
Links:
State Rating Period:
July 1, 2024
-
June 30, 2025
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Nursing facility services
Virginia
Uniform increase for inpatient and outpatient services at private acute care 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 $3.73 billion.
Approval Date:
May 20, 2024
Effective Date:
July 1, 2024
Links:
State Rating Period:
July 1, 2024
-
June 30, 2025
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
Nevada
Value-based payment established by the state for free standing nursing facilities for the rating period January 1, 2023 through December 31, 2023, incorporated in the capitation rates through a separate payment term up to $2.3 million.
Approval Date:
May 17, 2024
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
December 31, 2023
Payment Type:
Fee schedule
Value-based payment
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Nursing facility services
Michigan
The uniform dollar increase established by the state for direct care workers providing personal care services to eligible enrollees for the rating period covering October 1, 2023 through September 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
May 13, 2024
Effective Date:
October 1, 2023
Links:
State Rating Period:
October 1, 2023
-
September 30, 2024
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
HCBS/personal care services
Iowa
Uniform increase for inpatient and outpatient hospital services provided at qualifying non-state owned or operated hospitals as defined in the Medicaid State Plan for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $1,478,197,798.
Approval Date:
May 9, 2024
Effective Date:
July 1, 2024
Links:
State Rating Period:
July 1, 2024
-
June 30, 2025
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service