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
Tennessee
Uniform percentage increase and value-based payments established by the state for professional services at an academic medical center for the rating period, January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $16,638,000.
Approval Date:
February 13, 2024
Effective Date:
January 1, 2024
Links:
New Mexico
Renewal of the uniform increase established by the state for EPSDT services for Private Duty Nursing and Home Health Providers for the rating period covering January 1, 2024 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
February 9, 2024
Effective Date:
January 1, 2024
Links:
New Mexico
Renewal of the uniform increase established by the state for HCBS and personal care services for the rating period covering January 1, 2024 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
February 9, 2024
Effective Date:
January 1, 2024
Links:
Washington
Renewal of a uniform increase established by the state for qualified licensed professionals employed by the University of Washington and/or a member of its affiliated physician practice plans or employed by a public hospital or other public entity 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 $109 million.
Approval Date:
February 8, 2024
Effective Date:
January 1, 2024
Links:
Washington
Renewal of the uniform increase established by the state for eligible providers delivering opioid treatment 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:
February 8, 2024
Effective Date:
January 1, 2024
Links:
Washington
Renewal of the uniform increase established by the state for publicly funded sexual and reproductive health family planning providers as designated by the Department of Health 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 8, 2024
Effective Date:
January 1, 2024
Links:
Washington
Renewal of the uniform increase established by the state for behavioral health inpatient and behavioral health outpatient 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:
February 8, 2024
Effective Date:
January 1, 2024
Links:
Tennessee
Uniform percentage increase established by the state for eligible behavioral health 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:
February 5, 2024
Effective Date:
July 1, 2023
Links:
Tennessee
Uniform dollar increase and value-based payments established by the state for eligible primary care 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:
February 5, 2024
Effective Date:
January 1, 2024
Links:
New Jersey
A pay-for-performance initiative focused on maternal health performance improvement among acute care hospitals licensed to provide Labor and Delivery Services for the rating period covering July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term of up to $63,000,000.
Approval Date:
February 2, 2024
Effective Date:
July 1, 2024
Links: