The National Association of State Mental Health Program Directors (NASMHPD) commissioned TAC to author this case study of Oklahoma’s Enhanced Tier Payment System (ETPS). The ETPS leverages Medicaid financing to incentivize mental health providers for quality improvement of care. The paper describes the overall ETPS system design, the stakeholder engagement process, and the process for obtaining approval from the federal Centers for Medicare and Medicaid Services (CMS). (2011)