Director, Managed Care Group

0938-AV69 202504 Unified Agenda of Federal Regulatory and Deregulatory Actions 0938 Centers for Medicare & Medicaid Services CMS 0900 Department of Health and Human Services HHS Medicaid Managed Care State Directed Payments and Medicaid Fee-For-Service Targeted Medicaid Practitioner Payments (CMS-2449)

This rule would propose alternatives to 42 CFR 438.6(c) to modify the limit on the total payment rate and other requirements for state directed payments in Medicaid Managed Care. CMS would propose these changes based on its authority to interpret and implement section 1903(m)(2)(A)(iii) of the Social Security Act, which requires contracts between States and Managed Care Organizations to provide payments under a risk-based contract for services and associated administrative costs that are actuarially sound. This rule also proposes to set a limit for certain targeted Medicaid practitioner payments in Medicaid fee-for-service.

]]> Economically Significant First Time Published in The Unified Agenda Proposed Rule Stage Yes No Regulatory 42 CFR 438 42 U.S.C. 1302 No NPRM 07/00/2025 Undetermined Federal State No No No John Giles Director, Managed Care Group 0938 Centers for Medicare & Medicaid Services CMS 410 786-1255 john.giles1@cms.hhs.gov Center for Medicaid and CHIP Services, MS: S2-26-12, 7500 Security Boulevard, Baltimore MD 21244