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
Pennsylvania
The alternative fee schedule for ambulance services owned and operated by the Cities of Pittsburgh and Philadelphia 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:
December 27, 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:
Other
California
Uniform dollar increase established by the state for developmental screening services 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:
December 27, 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:
Other
California
Uniform dollar increase established by the state for Family Planning services 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:
December 27, 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:
Other
California
Quality Incentive Pool for District and Municipal Public Hospital Systems for the rating periods covering January 1, 2021 through December 31, 2023, incorporated in the CY 2023 capitation rates through a separate payment term of up to $192,062,936.53.
Approval Date:
December 27, 2023
Effective Date:
January 1, 2021
Links:
State Rating Period:
January 1, 2021
-
December 31, 2023
Payment Type:
Value-based payment
Review Type:
Amendment
Approval Period:
Multiple Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
California
Quality Incentive Pool for Designated Public Hospital systems for the rating periods covering January 1, 2021 through December 31, 2023, incorporated in the CY 2023 capitation rates through a separate payment term of up to $2,040,316,388.17.
Approval Date:
December 27, 2023
Effective Date:
January 1, 2021
Links:
State Rating Period:
January 1, 2021
-
December 31, 2023
Payment Type:
Value-based payment
Review Type:
Amendment
Approval Period:
Multiple Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
Massachusetts
Continuous Quality Improvement (CQI) value-based payment arrangement established by the state for private acute hospitals for the rating period covering January 1, 2023 through March 31, 2023, incorporated into the capitation rates through a separate payment term of up to $37,876,200.
Approval Date:
December 27, 2023
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
March 31, 2023
Payment Type:
Value-based payment
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
Minnesota
Minimum fee schedule established by the state for eligible inpatient and outpatient hospital services, professional services at an academic medical center, ambulance services, and anesthesia services for the rating period, January 1, 2023 through December 31, 2023, incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
December 27, 2023
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
December 31, 2023
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Other
Outpatient hospital service
Professional services at an academic medical center
Minnesota
Minimum fee schedule established by the state for eligible inpatient and outpatient hospital services, professional services at an academic medical center, ambulance services, and anesthesia services for the rating period, January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
December 27, 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
Other
Outpatient hospital service
Professional services at an academic medical center
Missouri
Minimum fee schedule for Community Mental Health Clinics 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:
December 27, 2023
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Behavioral health outpatient services
Nevada
Uniform increase for eligible professional services at designated academic medical centers for the rating period covering January 1, 2022 through December 31, 2022, incorporated in the capitation rates through a separate payment term of up to $20,386,808.36.
Approval Date:
December 27, 2023
Effective Date:
January 22, 2022
Links:
State Rating Period:
January 22, 2022
-
December 31, 2022
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Professional services at an academic medical center