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
Minimum Fee Schedule established by the State for the Program of Assertive Community Treatment (PACT) for the rating period covering April 1, 2023 through December 31, 2023, incorporated into the capitation rates through a risk-based adjustment.
Approval Date:
May 7, 2024
Effective Date:
April 1, 2023
Links:
Massachusetts
The uniform increase for behavioral health outpatient services and behavioral health diversionary services established by the state for the rating period covering April 1, 2023 through December 31, 2023, incorporated into the capitation rates through a risk-based adjustment.
Approval Date:
May 7, 2024
Effective Date:
April 1, 2023
Links:
Massachusetts
The minimum fee schedule for Acute Treatment Services (ATS) and Clinical Support Services (CSS) (which may include individualized treatment services in a specialized setting), and Residential Rehabilitation Services (RRS) services established by the state for the rating period covering April 1, 2023 through December 31, 2023, incorporated into the capitation rates through a risk-based adjustment.
Approval Date:
May 7, 2024
Effective Date:
April 1, 0023
Links:
Louisiana
Uniform increase for in-state providers of inpatient and outpatient hospital services, excluding freestanding psychiatric hospitals, freestanding rehabilitation hospitals, and long-term acute care hospitals for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $2,806,800,000.
Approval Date:
May 6, 2024
Effective Date:
July 1, 2024
Links:
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:
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:
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:
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
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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
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:
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: