Both The Medicaid and CHIP Access and Payment Commission and the Government Accountability Office have recently published recommendations for increasing transparency of managed care directed payment programs to facilitate closer evaluation of direct payment programs. MACPAC has released its June 2022 […]
In December, CMS approved some of California’s CalAim proposals through extensions of its 1115 demonstration and 1915(b) managed care waivers. California is transitioning significant programs under its prior 1115 waiver into its 1915(b) waiver, and working to sustain support for […]
On January 8, 2021, CMS published a revised managed care directed payment preprint application as part of its new guidance on directed payments released the same day. The revised preprint incorporates additional questions and more detailed tables, many of which […]
On January 8, 2021, the Centers for Medicare & Medicaid Services (CMS) issued a State Medicaid Director Letter (SMDL) outlining additional guidance on Medicaid managed care directed payments, as well as a revised preprint form for use in seeking approval […]
On November 9, 2020, CMS issued a managed care rule that largely finalizes policies proposed by the agency in a November 2018 proposed rule. Among other things, the final rule would eliminate prior approval requirements for directed payments implementing minimum fee schedules based […]
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 […]
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 […]
Just prior to the end of the Obama administration, on January 18, 2017, CMS published a final rule limiting the ability of states to create new or increased pass-through payments to providers in their Medicaid managed care programs. The rule’s […]
CMS issues proposed rule that would limit the ability of states to create new or increased pass-through payments to providers in their Medicaid managed care programs. In its final Medicaid managed care rule issued last spring, CMS had explicitly allowed states to […]
On Nov. 10, 2016, CMS issued its first set of Frequently Asked Questions on the Medicaid Managed Care Final Rule published in May. For more information on the Final Rule and the latest explanatory guidance, see our Medicaid Managed Care Resources […]
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