Federal Register #2026-10292

CMS Proposed Rule: Medicaid Payment Limits and Oversight for State Directed and Targeted Payments

CMS is proposing new rules to limit Medicaid State Directed Payments (SDPs) and Fee-for-Service (FFS) targeted payments, aiming to align payment rates with Medicare and improve fiscal integrity. - Government Buyer: - Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services - Products/Services Requested: - State Directed Payments (SDPs) for Medicaid managed care providers - Includes inpatient hospital services, outpatient hospital services, nursing facility services, and qualified practitioner services at academic medical centers - Fee-for-Service (FFS) Targeted Medicaid Payments - Supplemental payments to subsets of practitioners/providers (physicians, dentists, emergency medical transportation providers, other licensed practitioners) - Unique/Notable Requirements: - Payment limits set at 100% of Medicare rates for Expansion States and 110% for Non-Expansion States - Temporary grandfathering and phase-down period for existing SDPs - Enhanced oversight, documentation, and compliance requirements - Applies to all 50 States, DC, and U.S. territories - No specific OEMs or commercial vendors are mentioned, as this is a regulatory action - No part numbers or purchase quantities requested - Places of performance include all U.S. States, DC, territories, and CMS federal offices in Baltimore, MD

Description

This proposed rule describes alternatives to modify the limit on the total payment rate and other requirements for State directed payments in Medicaid managed care. It also proposes to set a limit for certain targeted Medicaid payments in Medicaid fee-for-service. The rule is issued by the Centers for Medicare & Medicaid Services under the authority of sections 1902(a)(4), 1903(m)(2)(A)(iii), and 1902(a)(30)(A) of the Social Security Act. Comments are due by July 21, 2026.

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