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
Puerto Rico
Minimum fee schedule established by Puerto Rico for dental services for the rating period covering January 1, 2023 through September 30, 2023 incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
February 16, 2023
Effective Date:
January 1, 2023
Links:
North Carolina
Uniform dollar increase established by the state for the professional services at academic medical centers 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 $89,528,544.
Approval Date:
February 13, 2023
Effective Date:
July 1, 2022
Links:
West Virginia
Uniform Increase for eligible Acute Care Hospitals established by the state for Inpatient, Outpatient, and 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 $343,997,344.
Approval Date:
February 10, 2023
Effective Date:
July 1, 2022
Links:
Puerto Rico
Minimum fee schedules for specialty physician services and behavioral health outpatient services for the rating periods covering January 1, 2023 through September 30, 2023 incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
February 10, 2023
Effective Date:
January 1, 2023
Links:
Pennsylvania
Uniform increase for inpatient and outpatient hospital services established by the state 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 $1.156 billion.
Approval Date:
February 10, 2023
Effective Date:
January 1, 2023
Links:
Oregon
Uniform increase established by the state for ground emergency medical transportation 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 $20,531,555.
Approval Date:
February 10, 2023
Effective Date:
January 1, 2023
Links:
Maryland
Uniform percentage increase and value-based payment established by the state for professional services at an academic medical center, primary care services, specialty physician services, and qualifying practitioner services for the rating period covering January 1, 2022 through December 31, 2024 incorporated in the capitation rates through a separate payment term of up to $37.8 million.
Approval Date:
February 10, 2023
Effective Date:
January 1, 2022
Links:
Tennessee
Minimum and maximum fee schedules established by the state for select inpatient and outpatient services provided at eligible hospitals 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 6, 2023
Effective Date:
January 1, 2023
Links:
Pennsylvania
Value-based payment arrangement for opioid use disorder for private acute care hospitals 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 $35 million.
Approval Date:
February 3, 2023
Effective Date:
January 1, 2023
Links:
Pennsylvania
Nursing Facility Quality Incentive established by the state 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 $15 million.
Approval Date:
February 3, 2023
Effective Date:
January 1, 2023
Links: