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
Uniform increase established by the state for eligible home and community-based service (HCBS) providers for the rating period covering April 1, 2023 through December 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
July 2, 2024
Effective Date:
April 1, 2023
Links:
Massachusetts
Uniform increase established by the state for eligible home and community-based service (HCBS) providers for the rating period covering January 1, 2023 through December 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
July 2, 2024
Effective Date:
January 1, 2023
Links:
Mississippi
Uniform percentage increase and performance improvement initiative payments established by the state for inpatient and outpatient hospital 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 $1,565,840,324.
Approval Date:
June 26, 2024
Effective Date:
July 1, 2024
Links:
New York
Minimum fee schedules established by the state for eligible primary care providers who have active New York State Patient Centered Medical Home (PCMH) recognition for assigned members for the rating period, April 1, 2024 through March 31, 2025, incorporated into the capitation rates through a separate payment term up to $203,730,871.
Approval Date:
June 26, 2024
Effective Date:
April 1, 2024
Links:
Florida
Uniform percentage increase established by the state for primary care services and specialty physician services at public hospitals for the rating period, October 1, 2023 through September 30, 2024, incorporated into the capitation rates through a separate payment term up to $94,789,865.
Approval Date:
June 24, 2024
Effective Date:
October 1, 2023
Links:
Michigan
Minimum fee schedule authorized for the administration and services of Methadone established by the state for behavioral health outpatient services for the rating period, October 1, 2023 through September 30, 2024, incorporated into the capitation through a risk based rate adjustment.
Approval Date:
June 24, 2024
Effective Date:
October 1, 2023
Links:
Ohio
The Care Innovation and Community Improvement Program established by the state for the rating period covering January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a risk based rate adjustment and a separate payment term up to $28,091,682.
Approval Date:
June 21, 2024
Effective Date:
January 1, 2024
Links:
Washington
The uniform percentage increase established by the state for inpatient and outpatient hospital services provided by eligible Critical Access Hospitals and Prospective Payment System Hospitals for the rating period January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term up to $1.818 billion.
Approval Date:
June 14, 2024
Effective Date:
January 1, 2024
Links:
Wisconsin
Uniform percentage increase established by the state for eligible home and community-based service (HCBS) providers for the rating period, January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
June 13, 2024
Effective Date:
January 1, 2024
Links:
Massachusetts
Uniform increase established by the state for eligible inpatient and outpatient hospital services for the rating period covering April 1, 2023 through December 31, 2023, incorporated into the capitation rates through a separate payment term up to $181,924,825.
Approval Date:
May 31, 2024
Effective Date:
April 1, 2023
Links: