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
North Carolina
Minimum fee schedule for non-state government owned skilled nursing facility admission days for the rating period, July 1, 2022 through June 30, 2023, incorporated into the capitation rates through an adjustment to base rates.
Approval Date:
January 31, 2024
Effective Date:
July 1, 2022
Links:
Arizona
Uniform percentage increase to registered providers who provide qualifying HCBS and Behavioral Health Outpatient services for the rating period, October 1, 2022 through September 30, 2023, incorporated into the capitation rates through a separate payment term up to $385.1 million.
Approval Date:
January 24, 2024
Effective Date:
October 1, 2022
Links:
Ohio
Uniform increase established by the state for inpatient and outpatient services provided by in-state hospitals for the rating period covering January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $1.762 billion.
Approval Date:
January 23, 2024
Effective Date:
January 1, 2024
Links:
Ohio
Uniform percentage increase for inpatient and outpatient services at the University of Toledo Medical Center for the rating period covering January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term up to $44,400,000.00.
Approval Date:
January 23, 2024
Effective Date:
January 1, 2024
Links:
Puerto Rico
Minimum fee schedule established by the state for dental services for the rating period covering October 1, 2023 through September 30, 2024 incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
January 23, 2024
Effective Date:
October 1, 2023
Links:
Puerto Rico
Minimum fee schedule established by the state for eligible primary care services for the rating period covering October 1, 2023 through September 30, 2024 incorporated in the capitation rates through a risk-based adjustment.
Approval Date:
January 23, 2024
Effective Date:
October 1, 2023
Links:
Puerto Rico
Minimum fee schedule established by the state for primary care services that are covered at 75% of Medicare consistent with the requirements of the Consolidated Appropriations Act of 2023 for the rating period covering October 1, 2023 through September 30, 2024 incorporated in the capitation rates through a risk-based adjustment.
Approval Date:
January 23, 2024
Effective Date:
October 1, 2023
Links:
Rhode Island
The Total Cost of Care for the state’s Accountable Entities, as authorized in the state’s section 1115 demonstration, for the rating period covering July 1, 2023 through June 30, 2024.
Approval Date:
January 22, 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 $344,047,623.
Approval Date:
January 22, 2024
Effective Date:
January 1, 2024
Links:
Kentucky
Uniform dollar increase established by the state for eligible ground ambulance providers for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a through a separate payment term of up to $61,159,581.
Approval Date:
January 19, 2024
Effective Date:
January 1, 2024
Links: