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
Louisiana
Uniform increase for inpatient and outpatient hospital services by eligible in-state hospital providers of long-term acute care, psychiatric services, and rehabilitation services for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $54,400,000.
Approval Date:
May 6, 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
California
Uniform increase established by the State for Skilled Nursing Facility (SNF) Workforce and Quality Incentive Program (WQIP) eligible providers for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $295,393,244.
Approval Date:
May 1, 2024
Effective Date:
January 1, 2024
Links:
State Rating Period:
January 1, 2024
-
December 31, 2024
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Nursing facility services
Iowa
Uniform increase for physician and professional services provided at qualifying Iowa state-owned or operated professional services practices 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 $137,560,533.79.
Approval Date:
May 1, 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:
Professional services at an academic medical center
Vermont
Value-based payment arrangement for developmental disabilities services for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
April 30, 2024
Effective Date:
January 1, 2024
Links:
State Rating Period:
January 1, 2024
-
December 31, 2024
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
HCBS/personal care services
Vermont
Value-based payment arrangement for the Vermont Medicaid Next Generation (VMNG) ACO program for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
April 30, 2024
Effective Date:
January 1, 2024
Links:
State Rating Period:
January 1, 2024
-
December 31, 2024
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
Primary care services
Professional services at an academic medical center
Specialty physician services
Illinois
Uniform increase established by the state for inpatient and outpatient services at hospitals participating in delivery system transformation programs approved by the state for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $149,000,000.
Approval Date:
April 26, 2024
Effective Date:
January 1, 2024
Links:
State Rating Period:
January 1, 2024
-
December 31, 2024
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
North Carolina
Uniform dollar increase established by the state for the professional services at academic medical centers for the rating period covering July 1, 2023 through June 30, 2024 incorporated in the capitation rates through a separate payment term of up to $83,547,311.
Approval Date:
April 26, 2024
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Professional services at an academic medical center
Puerto Rico
Uniform dollar increase for inpatient hospital services at qualifying short-term acute care (STAC) hospitals for the rating period covering October 1, 2023 through September 30, 2024 incorporated in the capitation rates through a separate payment term of up to $135,978,450.
Approval Date:
April 26, 2024
Effective Date:
October 1, 2023
Links:
State Rating Period:
October 1, 2023
-
September 30, 2024
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Vermont
Value-based payment arrangement for the High-Technology Nursing Program for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
April 26, 2024
Effective Date:
January 1, 2024
Links:
State Rating Period:
January 1, 2024
-
December 31, 2024
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Other
North Carolina
Uniform dollar increase established by the state for eligible behavioral health inpatient 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:
April 19, 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