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
Michigan
Uniform dollar increase for psychiatric inpatient days for the rating period covering October 1, 2024 through September 30, 2025 incorporated in the capitation rates through a separate payment term of up to $297,800,000.
Approval Date:
May 8, 2025
Effective Date:
October 1, 2024
Links:
State Rating Period:
October 1, 2024
-
September 30, 2025
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Behavioral health inpatient service
Pennsylvania
Value-based payment arrangement for opioid use disorder for private acute care hospitals for the rating period covering January 1, 2025 through December 31, 2027, incorporated in the capitation rates through a separate payment term of up to $35 million per annual rating period.
Approval Date:
May 8, 2025
Effective Date:
January 1, 2025
Links:
State Rating Period:
January 1, 2025
-
December 31, 2027
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Multiple Rating Period
Provider Class:
Outpatient hospital service
Mississippi
Uniform dollar increase established by the state for inpatient hospital services, primary care services, and specialty physician 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 $6,603,083.
Approval Date:
May 6, 2025
Effective Date:
July 1, 2024
Links:
State Rating Period:
July 1, 2024
-
June 30, 2025
Payment Type:
Fee schedule
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Primary care services
Specialty physician services
Pennsylvania
Value-based payment arrangement focused on potentially preventable admissions for private acute care hospitals for the rating periods covering January 1, 2025 through December 31, 2027, incorporated in the capitation rates through a separate payment term of up to $45 million per annual rating period.
Approval Date:
May 6, 2025
Effective Date:
January 1, 2025
Links:
State Rating Period:
January 1, 2025
-
December 31, 2027
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Multiple Rating Period
Provider Class:
Inpatient hospital service
Virginia
The minimum fee schedule established by the state for Durable Medical Equipment
providers for the rating period covering July 1, 2025 through June 30, 2026, incorporated
in the capitation rates through a risk-based rate adjustment.
Approval Date:
May 6, 2025
Effective Date:
July 1, 2025
Links:
State Rating Period:
July 1, 2025
-
June 30, 2026
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Other
New Hampshire
The uniform dollar increase for inpatient discharges and outpatient visits to qualifying non-critical access hospitals for the rating period covering September 1, 2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term of up to $32,413,757.
Approval Date:
May 5, 2025
Effective Date:
September 1, 2024
Links:
State Rating Period:
September 1, 2024
-
June 30, 2025
Payment Type:
Fee schedule
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
Pennsylvania
The value based payment arrangement providing incentive payments to acute care general hospitals established by the state for the rating periods covering January 1, 2025through December 31, 2027, incorporated in the capitation rates through a separate payment term of up to $30 million per annual rating period.
Approval Date:
May 5, 2025
Effective Date:
January 1, 2025
Links:
State Rating Period:
January 1, 2025
-
December 31, 2027
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Multiple Rating Period
Provider Class:
Inpatient hospital service
Illinois
Uniform dollar increase for nursing facilities based on quality weighted Medicaid days for the rating period covering January 1, 2023 through December 31, 2023, and incorporated in the capitation rates through a separate payment term of up to $58million.
Approval Date:
May 1, 2025
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
December 31, 2023
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Nursing facility services
New Hampshire
The uniform dollar increase for inpatient discharges and outpatient visits to qualifying critical access hospitals for the rating period covering September 1, 2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term of up to $56,120,600.
Approval Date:
May 1, 2025
Effective Date:
September 1, 2024
Links:
State Rating Period:
September 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
Missouri
Uniform dollar increase for government-owned or operated ground ambulance providers for the rating period covering July 1, 2024, through June 30, 2025, incorporated in the capitation rates through a separate payment term amount of up to $80,253,305.
Approval Date:
May 1, 2025
Effective Date:
January 1, 2025
Links:
State Rating Period:
July 1, 2024
-
June 30, 2025
Payment Type:
Fee schedule
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Other