CMS Proposes New Limits On Medicaid State-Directed Payments, Projects $775 Billion In Savings Over 10 Years

The Centers for Medicare & Medicaid Services (CMS) issued proposed rules to limit Medicaid managed care state-directed payments (SDPs) and fee-for-service (FFS) targeted practitioner payments. The proposal is intended to align Medicaid payment levels more closely with Medicare payment standards and establish new national limits on these payment arrangements.

Under the proposed rule, CMS would:

Cap SDP provider payment rates at 100% of Medicare payment rates for Medicaid expansion states and 110% of Medicare payment rates for non-expansion states, or at 100% of the Medicaid state plan rate if a comparable Medicare rate is unavailable

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