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
Minnesota
Value-based purchasing established by the state for the Integrated Health Partnership for eligible inpatient and outpatient hospital services, professional services at an academic medical center, primary care services, specialty physician services, and inpatient and outpatient behavioral health services for the rating period, January 1, 2024 through December 31, 2026, incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
March 27, 2024
Effective Date:
January 1, 2024
Links:
State Rating Period:
January 1, 2024
-
December 31, 2026
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Multiple Rating Period
Provider Class:
Behavioral health inpatient service
Behavioral health outpatient services
Inpatient hospital service
Outpatient hospital service
Primary care services
Professional services at an academic medical center
Specialty physician services
New Jersey
Uniform increase for nursing facility services provided by Class II (publicly owned)
nursing facilities with greater than 500 licensed beds for the rating period, July 1, 2024
through June 30, 2025, incorporated into the capitation rates through a separate payment
term up to $18,207,438.
Approval Date:
March 27, 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:
Nursing facility services
Wisconsin
Uniform percentage increase for Family Care and Family Care Partnership which is established by the state for eligible home and community-based service (HCBS) providers 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:
March 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:
HCBS/personal care services
New Mexico
The uniform increase established by the state for outpatient services delivered by state-owned hospitals that receive funding through the Miners’ Trust Fund for the rating period covering January 1, 2024 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $2,340,000.
Approval Date:
March 25, 2024
Effective Date:
January 1, 2024
Links:
State Rating Period:
January 1, 2024
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Outpatient hospital service
Louisiana
Uniform dollar increase for pediatric home health nurses established by the state for
home health services for the rating period, July 1, 2023 through June 30, 2024,
incorporated into the capitation rates through a separate payment term up to $3,307,280.
Approval Date:
March 22, 2024
Effective Date:
January 1, 2024
Links:
State Rating Period:
July 1, 2023
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
HCBS/personal care services
Vermont
Value-based payment arrangement for Vermont’s Northeastern Family Institute 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:
March 22, 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:
Behavioral health outpatient services
Georgia
The uniform percentage increase for inpatient and outpatient hospital services furnished by eligible teaching hospitals established by the state 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 $936,920,135.
Approval Date:
March 21, 2024
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
Pennsylvania
Value-based purchasing established by the state for eligible nursing facility services for the rating period, January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $15,000,000.
Approval Date:
March 21, 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:
Nursing facility services
Washington
Uniform increase for hospitals owned or operated by a state university established by the state for inpatient and outpatient hospital services for the rating period, January 1, 2024through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $433 million.
Approval Date:
March 21, 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
Wisconsin
Uniform increase established by the state for eligible home and community-based service (HCBS) providers for the rating period covering July 1, 2023 through December 31, 2024, incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
March 21, 2024
Effective Date:
July 1, 2023
Links:
State Rating Period:
March 21, 2024
-
July 1, 2023
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
HCBS/personal care services