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HHS/CMS RIN: 0938-AT50 Publication ID: Fall 2019 
Title: Medicaid Fiscal Accountability (CMS–2393–P) 

This proposed rule aims to increase accountability, transparency, and clarity through improved reporting of Medicaid payments.

Agency: Department of Health and Human Services(HHS)  Priority: Economically Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Proposed Rule Stage 
Major: Yes  Unfunded Mandates: No 
EO 13771 Designation: Other 
CFR Citation: 42 CFR 430    42 CFR 433    42 CFR 447    42 CFR 455    ...     (To search for a specific CFR, visit the Code of Federal Regulations.)
Legal Authority: 42 U.S.C. 1302   
Legal Deadline:  None

Statement of Need:

To improve the operation and oversight of the Medicaid program, CMS needs more complete, reliable, and timely information regarding the distribution and funding of supplemental payments authorized in a State’s Medicaid State plan, including Medicaid Disproportionate Share Hospital (DSH) payments. This proposed rule would increase the agency’s capacity to evaluate payments at a provider-specific level for both State plan services and demonstration programs, improve efforts to provide technical assistance to States, further the agency’s program integrity goals, and aid in developing future policies to increase transparency and accountability.The requirements proposed within this rule will also improve our ability to evaluate the necessity, effectiveness, and impact of supplemental provider payments and DSH payments.

Summary of the Legal Basis:

The authority for oversight of Medicaid payments for services is derived from section 1902(a) of the Social Security Act (the Act), particularly, 1902(a)(2), 1902(a)(4), 1902(a)(6) and 1902(a)(30)(A) of the Act. The authority for oversight of Medicaid program financing is defined in sections 1902(a)(2) and 1906(w) of the Act.  DSH payments and the oversight of such payments is authorized in section 1923(g) of the Act.


We considered not publishing this rule. However, we believe this rule would lead to better accountability and transparency with regard to supplemental payments, Medicaid financing and the reporting of payments associated with DSH. Currently, we do not have the necessary data at the provider level to perform adequate analysis and oversight of supplemental payments. Other alternatives considered will be included in the rule.

Anticipated Costs and Benefits:

The rule is not expected to be economically significant. Estimates of the cost and benefits of these provisions will be included in the rule.


Risks will be included in the published rule for comment.

Action Date FR Cite
NPRM  11/00/2019 
Regulatory Flexibility Analysis Required: No  Government Levels Affected: Federal, State 
Federalism: No 
Included in the Regulatory Plan: Yes 
RIN Data Printed in the FR: No 
Agency Contact:
Richard Kimball
Health Insurance Specialist
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Medicaid and CHIP Services, MS: S3-14-28, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-2278