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
No state
Value based payment for targeted investment program established by the state for primary care and behavioral health outpatient 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 $3.4 million.
Approval Date:
March 6, 2023
Effective Date:
October 1, 2021
Links:
West Virginia
Uniform Increase for eligible Acute Care Hospitals established by the state for Physician and Specialty Physician Services for the rating period covering July 1, 2022 through June 30, 2023, incorporated in the capitation rates through a separate payment term of up to $35,413,059.
Approval Date:
March 2, 2023
Effective Date:
July 1, 2022
Links:
Arkansas
Uniform dollar increase for psychiatric residential treatment facilities not located in hospitals 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 $5,102,154.
Approval Date:
March 2, 2023
Effective Date:
January 1, 2022
Links:
Utah
Alternative fee schedule established by the state for behavioral health services 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 1, 2023
Effective Date:
July 1, 2022
Links:
Washington
Uniform increase established by the state for behavioral health inpatient and behavioral health outpatient 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 24, 2023
Effective Date:
January 1, 2023
Links:
Washington
The uniform increase established by the state for eligible providers delivering opioid treatment 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 24, 2023
Effective Date:
January 1, 2023
Links:
Vermont
Value-based payment arrangement for the High-Technology Nursing Program 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:
Vermont
Value-based payment arrangement for the Vermont Medicaid Next Generation (VMNG) ACO program 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
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December 31, 2023
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
Primary care services
Professional services at an academic medical center
Specialty physician services
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:
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: