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
New Mexico
Renewal of the uniform percentage increase established by the state for qualified practitioners who are members of a practice plan under contract to provide professional services at a state-owned academic medical center 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 $34 million.
Approval Date:
February 27, 2024
Effective Date:
January 1, 2024
Links:
State Rating Period:
January 1, 2024
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Professional services at an academic medical center
Illinois
Uniform increase established by the state for professional services at encounter rate clinics in non-state government owned hospital systems 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 $111,900,000.
Approval Date:
February 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:
Other
Illinois
Uniform dollar increase for nursing facilities based on quality weighted Medicaid days 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 $49 million.
Approval Date:
February 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:
Nursing facility services
West Virginia
The Uniform Increase for eligible Acute Care Hospitals established by the state for Inpatient, Outpatient, and Physician Services 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 $270,573,649.
Approval Date:
February 23, 2024
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
June 30, 2024
Payment Type:
Fee schedule
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
West Virginia
Uniform Increase for eligible Acute Care Hospitals established by the state for Physician
and Specialty Physician Services 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 $71,070,955.
Approval Date:
February 23, 2024
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Other
Tennessee
Uniform percentage increase established by the state for eligible 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 $758,850,000.
Approval Date:
February 22, 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
Tennessee
Uniform percentage increase and value-based payments established by the state for professional services at an academic medical center for the rating period, January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $16,638,000.
Approval Date:
February 13, 2024
Effective Date:
January 1, 2024
Links:
State Rating Period:
January 1, 2024
-
December 31, 2024
Payment Type:
Fee schedule
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Professional services at an academic medical center
New Mexico
Renewal of the uniform increase established by the state for EPSDT services for Private Duty Nursing and Home Health Providers for the rating period covering January 1, 2024 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
February 9, 2024
Effective Date:
January 1, 2024
Links:
State Rating Period:
January 1, 2024
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Other
New Mexico
Renewal of the uniform increase established by the state for HCBS and personal care services for the rating period covering January 1, 2024 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
February 9, 2024
Effective Date:
January 1, 2024
Links:
State Rating Period:
January 1, 2024
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
HCBS/personal care services
Washington
Renewal of a uniform increase established by the state for qualified licensed professionals employed by the University of Washington and/or a member of its affiliated physician practice plans or employed by a public hospital or other public entity 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 $109 million.
Approval Date:
February 8, 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:
Professional services at an academic medical center