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
Amendment of a value-based purchasing and uniform percent increase arrangement established by the state to increase nursing facility per diem rates by the market basket index (MBI) factor and to provide quality incentive payments for nursing facilities that meet performance requirements on specified quality metrics for the rating period covering January 1, 2024 through June 30, 2024, incorporated into the capitation rates through a risk-based adjustment.
Approval Date:
April 4, 2024
Effective Date:
January 1, 2024
Links:
Kansas
Uniform increase for professional services at an academic medical center provided by Qualified Licensed Professionals 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 $16,000,000.
Approval Date:
April 2, 2024
Effective Date:
January 1, 2024
Links:
New Mexico
The value-based payment and uniform increase established by the state for participating nursing facilities that demonstrate quality improvement 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:
April 2, 2024
Effective Date:
January 1, 2024
Links:
Washington
Uniform percentage increase for inpatient and outpatient services with designated public hospitals 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 $224.1 million.
Approval Date:
April 2, 2024
Effective Date:
January 1, 2024
Links:
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
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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:
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:
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:
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:
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: