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
Uniform percentage increase for inpatient and outpatient services for qualifying classes of 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 $259.9 million.
Approval Date:
December 12, 2023
Effective Date:
January 1, 2024
Links:
Iowa
A uniform increase for physician and professional services at qualifying Iowa state- owned or operated professional services practices as defined in the Medicaid State Plan for the rating period covering July 1, 2021 through June 30, 2022, incorporated into the capitation rates through a separate payment term of up to $106,546,734.
Approval Date:
December 8, 2023
Effective Date:
January 1, 2021
Links:
Iowa
A uniform increase to average commercial rate for inpatient hospital services and outpatient hospital services at qualifying Iowa state-owned or operated teaching hospitals as defined in the Medicaid State Plan for the rating period covering July 1, 2021 through June 30, 2022, incorporated into the capitation rates through a separate payment term of up to $468,662,600.
Approval Date:
December 8, 2023
Effective Date:
July 1, 2021
Links:
Pennsylvania
The alternative minimum fee schedule established by the state for qualifying providers under specific ASAM levels of care who provide substance use disorder (SUD) treatment 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 7, 2023
Effective Date:
January 1, 2024
Links:
Pennsylvania
The minimum fee schedule for providers involved in the Integrated Community Wellness Center (ICWC) 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 7, 2023
Effective Date:
January 1, 2024
Links:
Georgia
The uniform percentage increase for physician and other eligible professional services established by the state 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 $210,433,377.
Approval Date:
November 30, 2023
Effective Date:
July 1, 2023
Links:
Tennessee
Uniform percentage increase established by the state for nursing facility services for the rating period covering January 1, 2023 through December 31, 2023, incorporated in the capitation rates through a separate payment term of up to $174,025,614.
Approval Date:
November 29, 2023
Effective Date:
January 1, 2023
Links:
Tennessee
Uniform percentage increase established by the state for nursing facility services 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 $47,523,042.
Approval Date:
November 29, 2023
Effective Date:
January 1, 2024
Links:
New Mexico
A value-based purchasing and uniform percent increase arrangement established by the state to increase nursing facility per diem rates by the market basket index (MBI) factor and to provide quality incentive payments for nursing facilities that meet performance requirements on specified quality metrics for the rating period covering January 1, 2023 through December 31, 2023, incorporated into the capitation rates through a risk-based adjustment.
Approval Date:
November 28, 2023
Effective Date:
January 1, 2023
Links:
New Hampshire
Minimum fee schedule established by the state for durable medical equipment for the rating period covering July 1, 2023 through August 31, 2024, incorporated into the capitation rates through a risk-based rate adjustment
Approval Date:
November 27, 2023
Effective Date:
July 1, 2023
Links: