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
Nevada
Uniform percentage increase for inpatient and outpatient hospital services at non-state governmentally owned hospitals for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $197,169,083.
Approval Date:
May 15, 2025
Effective Date:
January 1, 2025
Links:
South Carolina
Uniform increase established by the state for emergency medical transport services provided by ground non-governmental ambulance services providers for rating periods covering July 1, 2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term amount of up to $8,183,729.
Approval Date:
May 15, 2025
Effective Date:
January 1, 2025
Links:
Delaware
Uniform percentage increase established by the state for personal care service claims for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
May 9, 2025
Effective Date:
January 1, 2025
Links:
Illinois
Uniform dollar increase for nursing facilities based on quality weighted Medicaid days for the rating period covering January 1, 2022 through December 31, 2022, and incorporated in the capitation rates through a separate payment term of up to $29million.
Approval Date:
May 8, 2025
Effective Date:
July 1, 2022
Links:
Michigan
Uniform dollar increase for psychiatric inpatient days for the rating period covering October 1, 2024 through September 30, 2025 incorporated in the capitation rates through a separate payment term of up to $297,800,000.
Approval Date:
May 8, 2025
Effective Date:
October 1, 2024
Links:
Pennsylvania
Value-based payment arrangement for opioid use disorder for private acute care hospitals for the rating period covering January 1, 2025 through December 31, 2027, incorporated in the capitation rates through a separate payment term of up to $35 million per annual rating period.
Approval Date:
May 8, 2025
Effective Date:
January 1, 2025
Links:
Mississippi
Uniform dollar increase established by the state for inpatient hospital services, primary care services, and specialty physician services for the rating period, July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term of up to $6,603,083.
Approval Date:
May 6, 2025
Effective Date:
July 1, 2024
Links:
Pennsylvania
Value-based payment arrangement focused on potentially preventable admissions for private acute care hospitals for the rating periods covering January 1, 2025 through December 31, 2027, incorporated in the capitation rates through a separate payment term of up to $45 million per annual rating period.
Approval Date:
May 6, 2025
Effective Date:
January 1, 2025
Links:
Virginia
The minimum fee schedule established by the state for Durable Medical Equipment
providers for the rating period covering July 1, 2025 through June 30, 2026, incorporated
in the capitation rates through a risk-based rate adjustment.
Approval Date:
May 6, 2025
Effective Date:
July 1, 2025
Links:
New Hampshire
The uniform dollar increase for inpatient discharges and outpatient visits to qualifying non-critical access hospitals for the rating period covering September 1, 2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term of up to $32,413,757.
Approval Date:
May 5, 2025
Effective Date:
September 1, 2024
Links: