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
Louisiana
A uniform dollar increase for psychotherapy services that utilize dialectical behavior therapy (DBT) for behavioral health outpatient services 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 $3,440,000.
Approval Date:
March 8, 2024
Effective Date:
January 1, 2024
Links:
Ohio
The Care Innovation and Community Improvement Program established by the state for the rating period covering January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a risk based rate adjustment and a separate payment term up to $28,091,682.
Approval Date:
March 7, 2024
Effective Date:
January 1, 2024
Links:
Michigan
Uniform dollar increase for psychiatric inpatient days for the rating period covering October 1, 2023 through September 30, 2024 incorporated in the capitation rates through a separate payment term of up to $215,800,000.
Approval Date:
March 6, 2024
Effective Date:
October 1, 2023
Links:
Illinois
Uniform increase established by the state for inpatient and outpatient services at large nonstate government 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 $575 million.
Approval Date:
March 5, 2024
Effective Date:
January 1, 2024
Links:
Illinois
Uniform increase established by the state for services provided by physicians employed
by State-owned medical schools 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 $113,300,000.
Approval Date:
March 5, 2024
Effective Date:
January 1, 2024
Links:
North Carolina
Minimum fee schedule for non-state government owned skilled nursing facility admission days and inpatient behavioral health stays based on actual utilization for the rating period, July 1, 2022 through June 30, 2023, incorporated into the capitation rates through an adjustment to base rates.
Approval Date:
March 5, 2024
Effective Date:
July 1, 2023
Links:
North Carolina
Uniform percentage increase established by the state for inpatient and outpatient hospital services and behavioral health inpatient and outpatient hospital services at eligible acute care and critical access hospitals for the rating period covering July 1, 2022 through June 30, 2023, incorporated in the capitation rates through a separate payment term of up to $2,889,672,115.
Approval Date:
March 5, 2024
Effective Date:
July 1, 2022
Links:
Massachusetts
Uniform increase established by the state for eligible home and community-based service (HCBS) providers 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:
February 28, 2024
Effective Date:
July 1, 2022
Links:
Massachusetts
Uniform increase established by the state for eligible home and community-based service (HCBS) providers 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:
February 28, 2024
Effective Date:
January 1, 2023
Links:
Oregon
Uniform dollar increases established by the state for ground emergency transportation providers 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 $26,065,794.
Approval Date:
February 28, 2024
Effective Date:
January 1, 2024
Links: