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
Value-based payment arrangement established by the state for eligible home and community-based service (HCBS) providers for the rating periods covering January 1, 2022 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $50,000,000.
Approval Date:
November 15, 2023
Effective Date:
January 1, 2022
Links:
New Jersey
A perinatal episode of care pilot established by the state for the rating period covering July 1, 2022 through June 30, 2023, incorporated into the capitation rates through a risk-based rate adjustment and a separate payment term of up to $3 million.
Approval Date:
November 13, 2023
Effective Date:
July 1, 2022
Links:
New Jersey
A perinatal episode of care pilot established by the state for the rating period covering July 1, 2023 through June 30, 2024 incorporated int the capitation rates through a risk-based rate adjustment and separate payment term of up to $3 million.
Approval Date:
November 13, 2023
Effective Date:
July 1, 2023
Links:
Nebraska
A uniform increase for practitioners who are acting in the capacity of an employee or contractor of the Public Academic Medical Institutions for the rating period covering January 1, 2023 through December 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
November 7, 2023
Effective Date:
January 1, 2023
Links:
Missouri
Uniform percentage increases for the professional services of designated providers affiliated with one of the qualifying hospitals 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 $68,300,368.37
Approval Date:
November 2, 2023
Effective Date:
July 1, 2023
Links:
New York
The value-based performance improvement initiative for qualifying Social Adult Day Care (SADC) sites established by the state for social adult daycare services for the rating period covering April 1, 2023 through March 31, 2024, incorporated in the capitation rates through a separate payment term of up to $14 million.
Approval Date:
October 31, 2023
Effective Date:
April 1, 2023
Links:
New York
The uniform increase for qualifying hospitals established by the state for inpatient services for the rating period covering April 1, 2023 through March 31, 2024, incorporated into the capitation rates through a separate payment term of up to $650 million.
Approval Date:
October 31, 2023
Effective Date:
April 1, 2023
Links:
Iowa
Uniform increase for all non-state owned or operated hospitals eligible to receive inpatient and/or outpatient payments consistent with the Medicaid State Plan 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 $1,300,000,000.
Approval Date:
October 27, 2023
Effective Date:
July 1, 2023
Links:
Iowa
Uniform increase established by the state for eligible ground emergency medical transportation providers 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:
October 27, 2023
Effective Date:
July 1, 2023
Links:
Missouri
Minimum and maximum fee schedules established by the state for inpatient hospital services 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:
October 27, 2023
Effective Date:
July 1, 2023
Links: