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
Pennsylvania
The value based payment arrangement providing incentive payments to acute care general hospitals established by the state for the rating periods covering January 1, 2025through December 31, 2027, incorporated in the capitation rates through a separate payment term of up to $30 million per annual rating period.
Approval Date:
May 5, 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, 2023 through December 31, 2023, and incorporated in the capitation rates through a separate payment term of up to $58million.
Approval Date:
May 1, 2025
Effective Date:
January 1, 2023
Links:
Missouri
Uniform dollar increase for government-owned or operated ground ambulance providers for the rating period covering July 1, 2024, through June 30, 2025, incorporated in the capitation rates through a separate payment term amount of up to $80,253,305.
Approval Date:
May 1, 2025
Effective Date:
January 1, 2025
Links:
New Hampshire
The uniform dollar increase for inpatient discharges and outpatient visits to qualifying 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 $56,120,600.
Approval Date:
May 1, 2025
Effective Date:
September 1, 2024
Links:
Nevada
Value-based payment established by the state for free standing nursing facilities for the rating period January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term up to $27,415,240.67.
Approval Date:
May 1, 2025
Effective Date:
January 1, 2024
Links:
Pennsylvania
Value-based payment arrangement for opioid use disorder for private acute care hospitals for the rating period covering January 1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term of up to $35 million.
Approval Date:
May 1, 2025
Effective Date:
January 1, 2024
Links:
Tennessee
Uniform percentage increase established by the state for nursing facility services for the rating period, January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term of up to $41,482,710.
Approval Date:
May 1, 2025
Effective Date:
January 1, 2025
Links:
Puerto Rico
Uniform dollar increase established by the state for inpatient hospital services for the rating period, October 1, 2024 through September 30, 2025, incorporated into the capitation rates through a separate payment term up of to $123,350,308.
Approval Date:
April 29, 2025
Effective Date:
October 1, 2024
Links:
Tennessee
Uniform percentage increase established by the state for inpatient and outpatient hospital services for the rating period, January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term of up to $3,204,114,577.
Approval Date:
April 29, 2025
Effective Date:
January 1, 2025
Links:
Wisconsin
Uniform percentage increase established by the state for eligible home and community-based services for the rating period, January 1, 2025 through December 31, 2025,incorporated into the capitation rates through a risk-based rate adjustment.
Approval Date:
April 29, 2025
Effective Date:
January 1, 2025
Links: