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
Ohio
Uniform percentage increase for HCBS and personal services care established by the state utilizing 9817 American Recovery Plan (ARP) funding for the rating period covering January 1, 2022 to December 31, 2022 incorporated in the capitation rates through separate payment term of up to $66,384,000.
Approval Date:
March 24, 2023
Effective Date:
March 1, 2022
Links:
No state
Alternative fee schedules established by the state for professional services provided by qualified providers affiliated with schools of medicine or dentistry who participate in the Medicaid Access to Physician Services (MAPS) program for the rating period covering July 1, 2022 through June 30, 2023 incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
March 24, 2023
Effective Date:
July 1, 2022
Links:
State Rating Period:
July 1, 2022
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June 30, 2023
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Behavioral health inpatient service
Behavioral health outpatient services
Dental services
Inpatient hospital service
Outpatient hospital service
Primary care services
Professional services at an academic medical center
Specialty physician services
Arizona
Value Based Payment for targeted Investment program established by the state for inpatient services provided at eligible hospitals 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 $1.7 million.
Approval Date:
March 21, 2023
Effective Date:
October 1, 2021
Links:
Tennessee
Value based payment arrangement and uniform dollar increase established by the state for physician practice plans affiliated with Tennessee’s public medical schools 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:
March 20, 2023
Effective Date:
January 1, 2023
Links:
Oregon
Uniform increase established by the state for inpatient and outpatient services provided by qualifying Public Academic Health Centers 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 $660,000,000.
Approval Date:
March 20, 2023
Effective Date:
January 1, 2023
Links:
No state
Uniform dollar increase for psychiatric inpatient days for the rating period covering October 1, 2022 through September 30, 2023 incorporated in the capitation rates through a separate payment term of up to $105 million.
Approval Date:
March 17, 2023
Effective Date:
October 1, 2022
Links:
Arizona
Value Based Payment for the targeted investment program for Primary Care Providers established by the state for the rating period covering October 1, 2021 through September 30, 2022 incorporated in the capitation rates through a separate payment term of up to $21.1 million.
Approval Date:
March 17, 2023
Effective Date:
October 1, 2021
Links:
Massachusetts
Value based payment arrangement for non-state, public hospitals that contract with the Commonwealth’s Prepaid Inpatient Health Plan (PIHP) to enhance the quality of behavioral health services provided on an outpatient and inpatient basis to MassHealth members for the rating period covering January 1, 2022 to December 31, 2022, incorporated in the capitation rates through a separate payment term of up to $52.65 million.
Approval Date:
March 15, 2023
Effective Date:
January 1, 2022
Links:
Massachusetts
Value based payment for Hospital Quality Incentive proposal 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 $296.0 million.
Approval Date:
March 15, 2023
Effective Date:
January 1, 2022
Links:
Massachusetts
Value Based Payment for Integrated Care Incentive proposal for non-state, public hospitals for the rating period covering January 1, 2022 to December 31, 2022, incorporated in the capitation rates through a separate payment term of up to $46.8 million.
Approval Date:
March 15, 2023
Effective Date:
January 1, 2022
Links: