On November 8, 2018, CMS released proposed regulations to amend the 2016 Medicaid Managed Care Rule. The proposed rule would allow states to establish new 3-year pass-through payments for populations transitioning into managed care, streamline the approval process for directed payments based on state plan rates, codify guidance allowing for multi-year approval of certain payment arrangements and permit states to certify rate ranges as actuarially sound in certain circumstances. CMS notes that these revisions are intended to support the Administration’s 3-pronged strategy of flexibility, accountability, and program integrity.