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HHS/CMS RIN: 0938-AV69 Publication ID: Spring 2025 
Title: ●Medicaid Managed Care State Directed Payments and Medicaid Fee-For-Service Targeted Medicaid Practitioner Payments (CMS-2449) 
Abstract:

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.

 
Agency: Department of Health and Human Services(HHS)  Priority: Economically Significant 
RIN Status: First time published in the Unified Agenda Agenda Stage of Rulemaking: Proposed Rule Stage 
Major: Yes  Unfunded Mandates: No 
EO 14192 Designation: Regulatory 
CFR Citation: 42 CFR 438   
Legal Authority: 42 U.S.C. 1302   
Legal Deadline:  None
Timetable:
Action Date FR Cite
NPRM  07/00/2025 
Regulatory Flexibility Analysis Required: Undetermined  Government Levels Affected: Federal, State 
Federalism: No 
Included in the Regulatory Plan: No 
RIN Data Printed in the FR: No 
Agency Contact:
John Giles
Director, Managed Care Group
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Medicaid and CHIP Services, MS: S2-26-12, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-1255
Email: john.giles1@cms.hhs.gov