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
Virginia
Uniform increase for physicians affiliated with the practice plans of Virginia’s three allopathic medical schools: University of Virginia, Virginia Commonwealth University, and Eastern Virginia Medical Center, 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 $224,900,000.
Approval Date:
April 17, 2024
Effective Date:
July 1, 2024
Links:
Missouri
Minimum and maximum fee schedules established by the state for inpatient hospital services for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
April 16, 2024
Effective Date:
July 1, 2024
Links:
Missouri
Minimum and maximum fee schedules established by the state for outpatient hospital services for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
April 16, 2024
Effective Date:
July 1, 2024
Links:
Virginia
The minimum fee schedule established by the state for Durable Medical Equipment providers for the rating period covering July 1, 2024 through June 30, 2025, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
April 16, 2024
Effective Date:
July 1, 2024
Links:
Kansas
Uniform increase for inpatient and outpatient services provided by eligible hospitals as established by the state for the rating period, January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $397,295,435.
Approval Date:
April 15, 2024
Effective Date:
January 1, 2024
Links:
New Jersey
Uniform dollar increase for inpatient hospital services and behavioral health inpatient services provided by Ocean County hospitals for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $83,912,896.
Approval Date:
April 10, 2024
Effective Date:
July 1, 2024
Links:
New Jersey
Uniform dollar increase for inpatient hospital services provided by Passaic County hospitals for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $69,563,799.
Approval Date:
April 10, 2024
Effective Date:
July 1, 2024
Links:
New Mexico
A uniform percentage increase and quality incentive payment established by the state for inpatient and outpatient hospital services provided by Safety Net Care Pool hospital providers for the rating period covering January 1, 2024 through June 30, 2024, incorporated into the capitation rates through a separate payment term of up to $34,500,000.
Approval Date:
April 10, 2024
Effective Date:
January 1, 2024
Links:
South Carolina
Uniform increase established by the state to dispensing fees for Independent Community Pharmacies 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 $9,500,000.
Approval Date:
April 10, 2024
Effective Date:
July 1, 2024
Links:
New Jersey
Uniform dollar increase for inpatient hospital services provided by Mercer County hospitals for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $84,249,173.
Approval Date:
April 9, 2024
Effective Date:
July 1, 2024
Links: