On November 16, 2017, CMS issued additional guidance on the required review process when a state proposes to reduce reimbursement rates.The agency clarified that the analysis and monitoring procedures described in the regulations would no longer be required in various instances, including where the resultant rate would be above Medicare or average commercial rates, when the state has “actively worked with provider groups” to address rate change concerns, when the state is merely freezing rates or reducing the annual increase, and when services are primarily delivered through managed care, among others.