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
Oklahoma
A value-based payment program for State-operated and private organizations contracted as Community Mental Health Centers for behavioral health outpatient services for the rating period, April 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $46,316,476
Approval Date:
March 19, 2024
Effective Date:
April 1, 2024
Links:
Oklahoma
Uniform increase for physicians and other qualifying practitioners established by the state for the purpose of using funds generated by the Supplemental Hospital Offset Payment Program (SHOPP) fee which establishes a managed care provider incentive pool to support healthcare quality assurance and access improvement initiatives for the rating period, April 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $134,330,110.
Approval Date:
March 19, 2024
Effective Date:
April 1, 2024
Links:
Oregon
Renewal of the uniform increase established by the state for behavioral health services furnished by qualified providers 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:
Oregon
Renewal of the uniform increase established by the state for behavioral health services furnished by qualified providers 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:
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:
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:
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:
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:
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:
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: