Health Law Daily Wrap Up, ADMINISTRATION OF MEDICARE/MEDICAID PROGRAMS—PROPOSED RULES: Medicaid managed care state directed payments, Medicaid fee-for service targeted Medicaid practitioner payments proposed, (May 26, 2026)

By WK Editorial Staff

The proposed rule describes alternatives to modify the limit on the total payment rate and other requirements for State directed payments in Medicaid managed care.

CMS proposed changes based on authority to interpret and implement section 1902(a)(4) of the Social Security Act (the Act) with respect to prepaid inpatient health plans and prepaid ambulatory health plans, and section 1903(m)(2)(A)(iii) of the Act, which require that 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. The proposed rule also would set a limit for certain targeted Medicaid payments in Medicaid fee-for-service. CMS proposed the change based on its authority to interpret and implement section 1902(a)(30)(A) of the Act with respect to certain targeted Medicaid payments which require that payments be consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area (Proposed Rule, 91 Fed. Reg. 30400 (May 22, 2026)).

Dates. To be assured consideration, comments must be received by July 21, 2026.

FederalRegisterIssuances: ProposedRules CMSNews BillingNews ManagedCareNews MedicaidNews PartANews PartBNews