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
Virginia
Uniform increase for inpatient and outpatient services at private acute care hospitals for the rating period covering July 1, 2022 through June 30, 2023, incorporated in the capitation rates through a separate payment term of up to $2.88 billion.
Approval Date:
October 27, 2023
Effective Date:
July 1, 2022
Links:
Virginia
The minimum fee schedule established by the state for Durable Medical Equipment providers for the rating period covering October 1, 2023 through June 30, 2024, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
October 27, 2023
Effective Date:
October 1, 2023
Links:
Tennessee
Uniform dollar 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 covering January 1, 2023 through December 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
October 26, 2023
Effective Date:
January 1, 2023
Links:
Virginia
Uniform increase established by the state for physicians employed by or contracted with the non-state government owned general acute care academic medical center, for the rating period covering July 1, 2023 through September 30, 2023, incorporated in the capitation rates through a separate payment term of up to $432,500.
Approval Date:
October 26, 2023
Effective Date:
July 1, 2023
Links:
Virginia
Uniform increase for physicians affiliated with the practice plans of Virginia’s three allopathic medical schools: University of Virginia, Virginia Commonwealth University, and Eastern Virginia Medical Center, for the rating period covering July 1, 2023 through September 30, 2023, incorporated in the capitation rates through a separate payment term of up to $67,025,000.
Approval Date:
October 26, 2023
Effective Date:
July 1, 2023
Links:
Virginia
Uniform increase for inpatient and outpatient services rendered by non-state government owned acute care hospitals for the rating period covering July 1, 2023 through September 30, 2023, incorporated in the capitation rates through a separate payment term of up to $21,325,000.
Approval Date:
October 26, 2023
Effective Date:
July 1, 2023
Links:
Virginia
Uniform increase established by the state for physicians employed by or contracted with the non-state government owned general acute care academic medical center for the rating period covering October 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $1,297,500.
Approval Date:
October 26, 2023
Effective Date:
January 1, 2023
Links:
Virginia
Uniform increase for physicians affiliated with the practice plans of Virginia’s three allopathic medical schools: University of Virginia, Virginia Commonwealth University, and Eastern Virginia Medical Center, for the rating period covering October 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $201,075,000.
Approval Date:
October 26, 2023
Effective Date:
October 1, 2023
Links:
Virginia
Uniform increase for inpatient and outpatient services rendered by non-state government owned acute care hospitals for the rating period covering October 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term of up to $63,975,000.
Approval Date:
October 26, 2023
Effective Date:
October 1, 2023
Links:
Arizona
Uniform percentage increase, entitled Access to Professional Services Initiative, established by the state for qualified practitioners affiliated with one of the designated hospitals for the rating period covering October 1, 2023 through September 30, 2024, incorporated into the capitation rate through a separate payment term of up to $238.60 million.
Approval Date:
October 25, 2023
Effective Date:
October 1, 2023
Links: