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
Oregon
Renewal of uniform increase established by the state for behavioral health services furnished by qualified providers delivering services to members with co-occurring disorders (COD) for the rating period covering January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
March 19, 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:
Behavioral health outpatient services
California
Uniform increase for inpatient and outpatient services provided by private hospitals as
defined in CA Welfare & Institutions Code § 14169.51(ap) for the rating period covering
January 1, 2023 through December 31, 2023, incorporated in the capitation rates through
a separate payment term of up to $5,392,730,897.
Approval Date:
March 18, 2024
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
December 31, 2023
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
Illinois
Uniform increase established by the state for inpatient and outpatient services at eligible
Illinois hospitals 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
$4,674,700,000.00
Approval Date:
March 15, 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
Pennsylvania
Uniform percentage increase established by the state for inpatient and outpatient hospital services for the rating period, January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $2,335,007,317.
Approval Date:
March 14, 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
Michigan
The uniform dollar increase established by the state for direct care workers providing personal care services to eligible enrollees for the rating period covering October 1, 2023 until September 30, 2024 incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
March 12, 2024
Effective Date:
October 1, 2023
Links:
State Rating Period:
October 1, 2023
-
September 30, 2024
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
HCBS/personal care services
Florida
Maximum fee schedule established by the state for eligible inpatient and outpatient hospital services for the rating period, October 1, 2023 through September 30, 2024, incorporated into the capitation rates through a risk-based rate adjustment
Approval Date:
March 8, 2024
Effective Date:
October 1, 2023
Links:
State Rating Period:
October 1, 2023
-
September 30, 2024
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
Louisiana
A uniform dollar increase for psychotherapy services that utilize dialectical behavior therapy (DBT) for behavioral health outpatient services 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 $3,440,000.
Approval Date:
March 8, 2024
Effective Date:
January 1, 2024
Links:
State Rating Period:
January 1, 2024
-
December 31, 2024
Payment Type:
Fee schedule
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Behavioral health outpatient services
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:
March 7, 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
Primary care services
Professional services at an academic medical center
Specialty physician services
Michigan
Uniform dollar increase for psychiatric inpatient days 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 $215,800,000.
Approval Date:
March 6, 2024
Effective Date:
October 1, 2023
Links:
State Rating Period:
October 1, 2023
-
September 30, 2024
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Behavioral health inpatient service
Illinois
Uniform increase established by the state for inpatient and outpatient services at large nonstate government hospitals 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 $575 million.
Approval Date:
March 5, 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