CMS Proposes Limits on Medicaid Managed Care and Targeted Fee-for-Service Payments
AI-generated summary for informational purposes only. Not legal advice. See the original source for the authoritative text.
This proposed rule would change how states can make certain Medicaid payments to providers, especially in Medicaid managed care plans and targeted fee-for-service arrangements. CMS is considering new limits on total payment rates for state directed payments and new requirements around how those payments are structured. The proposal matters for state Medicaid agencies, managed care organizations, hospitals, practitioners, and other providers that receive Medicaid funding. Comments are due by July 21, 2026, and affected organizations may want to review whether the proposed limits could change provider payment levels, state financing strategies, or managed care contract terms.
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Key Changes
- Proposes alternatives to modify the total payment rate limit for Medicaid managed care state directed payments
- Would add or change requirements for how state directed payments are handled in Medicaid managed care contracts
- Proposes a payment limit for certain targeted Medicaid fee-for-service practitioner payments
Obligations
What this law requires
Submit comments on the proposed rule by July 21, 2026 to ensure CMS considers them.
When submitting comments, refer to file code CMS-2449-P and submit comments using only one of the listed submission methods.