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November 2, 2017

CMS Releases Guidance on Direct Payments To Providers Under Managed Care

CMS released additional guidance to states on development and approval of “directed payments”—payments that the state directs its managed care plans to make to identified classes of providers through their managed care contracts.  CMS newly defined this concept in its 2016 managed care rule.  The bulletin provides the template CMS requires states to use to propose a new directed payment and details on related reporting and evaluation.   In addition, CMS provides an appendix of examples of approvable payments based on existing state programs, and distinguishes payment proposals that are not subject to directed payment authority. Eyman Associates has been working with providers and their state Medicaid agencies to develop and successfully achieve federal approval of such payments.