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
Vermont
Value-based payment arrangement for the Applied Behavior Analysis (ABA) Tiered Payment Model 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:
February 24, 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:
Behavioral health outpatient services
Hawaii
Minimum fee schedule established by the state for primary care services, specialty physician services, obstetricians, gynecologists, nurse practitioners, advance practice registered nurses, and physician assistants as defined in the preprint 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:
February 23, 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:
Other
Primary care services
Specialty physician services
Arizona
Targeted Investment program established by the state for behavioral health outpatient ambulatory focus areas for the rating period covering October 1, 2021 through September 30, 2022, and incorporated in the capitation rates through a separate payment term of up to $22.4 million.
Approval Date:
February 23, 2023
Effective Date:
October 1, 2021
Links:
State Rating Period:
October 1, 2021
-
September 30, 2022
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Behavioral health outpatient services
Washington
Uniform increase established by the state for primary care services for all eligible providers 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:
February 23, 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:
Primary care services
Washington
Minimum fee schedule established by the state for trauma center physician 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:
February 22, 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:
Other
Washington
Uniform increase established by the state for publicly funded sexual and reproductive health family planning providers as designated by the Department of Health 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:
February 22, 2023
Effective Date:
January 1, 2023
Links:
State Rating Period:
February 22, 2023
-
January 1, 2023
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Other
Tennessee
Minimum and maximum fee schedules established by the state for specific providers 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:
February 21, 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:
Behavioral health inpatient service
Behavioral health outpatient services
HCBS/personal care services
Nursing facility services
Other
Tennessee
Value based payment arrangement and fee schedule for Patient-Centered Medical Homes program established by the state 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:
February 21, 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:
Primary care services
Kentucky
Uniform increase and value-based payment established by the state for inpatient and outpatient hospital 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 $2,665,905,589.
Approval Date:
February 21, 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:
Inpatient hospital service
Outpatient hospital service
Illinois
Value based payment arrangement established by the state for eligible primary care providers with the Lurie Children's Hospital All Hands Health Network (AHHN) for the rating periods covering January 1, 2023 through December 31, 2024 incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
February 21, 2023
Effective Date:
January 1, 2023
Links:
State Rating Period:
January 1, 2023
-
December 31, 2024
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Multiple Rating Period
Provider Class:
Primary care services