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
Michigan
Uniform increase established by the state for inpatient and outpatient hospital services for the rating period covering October 1, 2023 through September 30, 2024 incorporated into the capitation rates through a separate payment term up to $4,775,089,580.
Approval Date:
January 19, 2024
Effective Date:
October 1, 2023
Links:
Tennessee
Uniform percentage increase established by the state for eligible behavioral health inpatient and outpatient services at Comprehensive Child and Family Treatment agencies (CCFT) for the rating period, January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
January 18, 2024
Effective Date:
January 1, 2024
Links:
Tennessee
Uniform percentage increase established by the state for eligible inpatient and outpatient hospital services for the rating period, January 1, 2023 through December 31, 2023, incorporated into the capitation rates through a separate payment term up to $344,047,623.
Approval Date:
January 18, 2024
Effective Date:
January 1, 2023
Links:
Kentucky
Uniform increase and value-based payment established by the state for inpatient and outpatient hospital services 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 $2,427,458,497.
Approval Date:
January 12, 2024
Effective Date:
January 1, 2024
Links:
Hawaii
- Pay for performance arrangement established by the state for public and private nursing facilities as defined in the preprint 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 $2.71 million; and,
- Uniform dollar increase established by the state for nursing facility services within government-owned nursing facilities 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 $32.96 million.
Approval Date:
January 11, 2024
Effective Date:
January 1, 2024
Links:
Hawaii
- Pay for performance arrangement established by the state for public and private hospitals as defined in the preprint for the rating period covering January 1, 2024 through December 31, 2024 incorporated in the capitation rates through separate payment term of up to $46.15 million;
- Uniform dollar increase established by the state for safety net hospitals owned and operated by a government agency 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 $86.46 million;
- Uniform percentage increase established by the state for inpatient and outpatient hospital services within privately-owned hospital provider classes for the rating period covering January 1, 2024 to December 31, 2024 incorporated in the capitation rates through a separate payment term of up to $162.2 million; and,
- Minimum and Maximum fee schedule established by the state for in-state general acute hospitals and children’s hospital services within in-state general acute hospital provider classes for the rating period of January 1, 2024 to December 31, 2024 incorporated in the capitation rates through a risk-based adjustment.
Approval Date:
January 11, 2024
Effective Date:
January 1, 2024
Links:
Texas
Rural Access to Primary and Preventative Services (RAPPS) for the rating period covering September 1, 2023 through August 31, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
January 9, 2024
Effective Date:
September 1, 2023
Links:
Oregon
Renewal of uniform increase established by the state for inpatient and outpatient hospital services provided by Diagnosis-Related Group (DRG) 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 $703,000,000.
Approval Date:
January 4, 2024
Effective Date:
January 1, 2024
Links:
Oregon
Renewal of uniform increase established by the state for inpatient and outpatient hospital services provided by Rural Type A/B 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 $146,000,000.
Approval Date:
January 4, 2024
Effective Date:
January 1, 2024
Links:
Kentucky
- Uniform increase established by the state for inpatient and outpatient hospital services and professional services at an academic medical center for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based adjustment; and,
- Value-based payment established by the state for inpatient and outpatient hospital services and professional services at an academic medical center for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $380,395,158.
Approval Date:
January 4, 2024
Effective Date:
January 1, 2025
Links: