CMS Proposes New Limits on State Directed Payments and Targeted FFS Payments

CMS issued a proposed rule modifying limits on state directed payments in Medicaid managed care and establishing new limits on certain targeted payments in fee-for-service Medicaid. The rule invokes actuarial soundness requirements under section 1903(m)(2)(A)(iii) for managed care SDPs and section 1902(a)(30)(A) for FFS targeted payments. The proposed changes would affect how states structure supplemental payments to providers through MCO contracts and direct FFS arrangements. This rule represents CMS's most significant intervention in state payment flexibility since the 2016 managed care rule established the current SDP framework.

Managed Care · Finance