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 inpatient and outpatient hospital services provided by qualifying Public Academic Health Centers 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 $809,000,000.
Approval Date:
January 4, 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
Oregon
Renewal of uniform increase established by the state for inpatient and outpatient hospital services provided by Diagnosis-Related Group (DRG) 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 $703,000,000.
Approval Date:
January 4, 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
Oregon
Renewal of uniform increase established by the state for inpatient and outpatient hospital services provided by Rural Type A/B 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 $146,000,000.
Approval Date:
January 4, 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
Rhode Island
The value-based payment Patient Centered Medical Home (PCMH)-Kids initiative established by the state for eligible pediatric providers for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
January 3, 2024
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
June 30, 2024
Payment Type:
Fee schedule
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Primary care services
Massachusetts
Uniform increase established by the state for eligible inpatient and outpatient hospital services for the rating period covering January 1, 2023 through March 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
January 2, 2024
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
March 31, 2023
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
Massachusetts
Maximum Fee Schedule for MassHealth contracted acute hospitals (except for specialty cancer hospitals, freestanding pediatric hospitals for an inpatient discharge with a MassHealth DRG Weight of 3 or greater, and the acute hospital with a pediatric specialty unit for enrollees under the age of 21 at the time of admission for an inpatient discharge with a MassHealth DRG Weight of 3 or greater) for the rating period covering January 1, 2022 through December 31, 2022, incorporated in the capitation rates through a risk- based rate adjustment.
Approval Date:
December 29, 2023
Effective Date:
January 1, 2022
Links:
State Rating Period:
January 1, 2022
-
December 31, 2022
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
Massachusetts
Maximum Fee Schedule for MassHealth contracted acute hospitals (except for specialty cancer hospitals, freestanding pediatric hospitals for an inpatient discharge with a MassHealth DRG Weight of 3 or greater, and the acute hospital with a pediatric specialty unit for enrollees under the age of 21 at the time of admission for an inpatient discharge with a MassHealth DRG Weight of 3 or greater) for the rating period covering January 1, 2023 through March 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
December 29, 2023
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
March 31, 2023
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
California
Uniform dollar increase established by the state for dental services for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a risk-based adjustment.
Approval Date:
December 28, 2023
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:
Dental services
California
Uniform dollar increase established by the state for inpatient and outpatient hospital services at District 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 $207,290,924.
Approval Date:
December 28, 2023
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
Nursing facility services
Outpatient hospital service
Wisconsin
Minimum and maximum fee schedule for Sub-Acute Psychiatric Community-Based Psychiatric and Recovery Center Services for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a risk-based adjustment.
Approval Date:
December 28, 2023
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