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
Washington
Renewal of the uniform increase established by the state for primary care services for all eligible 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:
February 28, 2024
Effective Date:
January 1, 2024
Links:
Washington
The uniform increase established by the state for behavioral health inpatient and outpatient services delivered by eligible providers for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a through a risk-based adjustment.
Approval Date:
February 28, 2024
Effective Date:
January 1, 2024
Links:
Puerto Rico
Minimum Fee Schedule for professional and facility urgent care centers (CDTs) established by the state for the rating period, October 1, 2023 through September 30, 2024, incorporated into the capitation rates through a risk-based adjustment.
Approval Date:
February 27, 2024
Effective Date:
October 1, 2023
Links:
North Carolina
Uniform dollar increase and minimum fee schedule for home and community-based services and behavioral health outpatient services established by the state 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:
February 27, 2024
Effective Date:
July 1, 2023
Links:
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:
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:
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:
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:
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:
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: