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
California
Uniform dollar increase established by the state for developmental screening services 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 27, 2023
Effective Date:
January 1, 2024
Links:
California
Uniform dollar increase established by the state for Family Planning services 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 27, 2023
Effective Date:
January 1, 2024
Links:
Massachusetts
Minimum fee schedule for psychiatric services for enrollees under the age of 21 with Autism Spectrum Disorder or Intellectual or Developmental Disability (ASD/IDD) for the rating period covering January 1, 2023 through March 31, 2023, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
December 26, 2023
Effective Date:
January 1, 2023
Links:
Nevada
Uniform increase for inpatient and outpatient hospital services at non-state governmentally owned 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 $240,129,255.30.
Approval Date:
December 26, 2023
Effective Date:
January 1, 2024
Links:
Nevada
Uniform increase for eligible inpatient and outpatient services at eligible private 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 $748,780,840.
Approval Date:
December 26, 2023
Effective Date:
January 1, 2024
Links:
Nevada
Value based payment for Certified Community Behavioral Health Centers (CCBHCs) 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 $1,015,232.55.
Approval Date:
December 26, 2023
Effective Date:
January 1, 2023
Links:
Nevada
Value based payment for Certified Community Behavioral Health Centers (CCBHCs) 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 $1,522,848.22.
Approval Date:
December 26, 2023
Effective Date:
January 1, 2024
Links:
Pennsylvania
Uniform increase for professional services furnished by eligible physician practices 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 $38 million.
Approval Date:
December 26, 2023
Effective Date:
January 1, 2024
Links:
Pennsylvania
Minimum fee schedule for non-public and county nursing facility services for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a risk-based adjustment.
Approval Date:
December 26, 2023
Effective Date:
January 1, 2024
Links:
Pennsylvania
Uniform dollar increase for qualifying private duty nursing services delivered by eligible providers for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through risk-based adjustment.
Approval Date:
December 26, 2023
Effective Date:
January 1, 2024
Links: