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
Illinois
Uniform increase established by the state for services provided by physicians employed by State-owned medical schools for the rating period covering January 1, 2022 through December 31, 2022, incorporated in the capitation rates through a separate payment term of up to $84,000,000
Approval Date:
May 4, 2023
Effective Date:
January 1, 2022
Links:
State Rating Period:
January 1, 2022
-
December 31, 2022
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Professional services at an academic medical center
North Carolina
Uniform increase established by the state for behavioral health outpatient services and other eligible provider services for the rating period covering July 1, 2021 through June 30, 2022, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
May 4, 2023
Effective Date:
July 1, 2021
Links:
State Rating Period:
July 1, 2021
-
June 30, 2022
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Behavioral health outpatient services
Other
North Carolina
Uniform percentage increase established by the state for behavioral health outpatient services for the rating period covering July 1, 2021 through June 30, 2022, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
May 4, 2023
Effective Date:
July 1, 2021
Links:
State Rating Period:
July 1, 2021
-
June 30, 2022
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Behavioral health outpatient services
North Carolina
Uniform increase established by the state for home and community-based and behavioral health outpatient services for the rating period covering July 1, 2021 through June 30, 2022, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
May 4, 2023
Effective Date:
July 1, 2021
Links:
State Rating Period:
July 1, 2021
-
June 30, 2022
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Behavioral health outpatient services
HCBS/personal care services
North Carolina
Uniform increase established by the state for nursing facility services and behavioral health outpatient services for the rating period covering July 1, 2021 through June 30, 2022, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
May 4, 2023
Effective Date:
July 1, 2021
Links:
State Rating Period:
July 1, 2021
-
June 30, 2022
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Behavioral health outpatient services
Nursing facility services
New Mexico
The uniform increase for HCBS and personal care services 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:
May 4, 2023
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
December 31, 2023
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
HCBS/personal care services
Louisiana
Uniform increase for licensed mental health providers 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 $22,602,400.
Approval Date:
May 2, 2023
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Behavioral health outpatient services
Louisiana
Uniform increase for non-emergency medical transport providers 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 $5,618,693.
Approval Date:
May 2, 2023
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
June 30, 2024
Payment Type:
Fee schedule
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Other
Vermont
The value-based payment arrangement for community-based residential substance use treatment facilities 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:
May 2, 2023
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
December 31, 2023
Payment Type:
Value-based payment
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Other
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, 2023 through December 31, 2023, incorporated in the capitation rates through a separate payment term of up to $2.62 million;
• Uniform dollar increase established by the state for nursing facility services within government-owned nursing facilities 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 $32.14 million.
Approval Date:
May 1, 2023
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
December 31, 2023
Payment Type:
Fee schedule
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Nursing facility services