State Directed Payments | Medicaid

State Directed Payments | Medicaid

Today, the Centers for Medicare & Medicaid Services released a new CMCS Informational Bulletin (CIB) to provide states guidance on how to temporarily modify provider payment methodologies and capitation rates under their Medicaid managed care contracts to address the impacts of the public health emergency while preserving systems of care and access to services for Medicaid beneficiaries. This guidance provides several options that states can consider under their Medicaid managed care contracts, including:

1. Adjusting managed care capitation rates exclusively to reflect temporary increases in Medicaid fee-for-service (FFS) provider payment rates where an approved state directed payment requires plans to pay FFS rates;
2. Requiring managed care plans to make certain retainer payments allowable under existing authorities to certain habilitation and personal care providers to maintain provider capacity and access to services; and
3. Utilizing state directed payments to require managed care plans to temporarily enhance provider payment under the contract.

In addition to the options described in this guidance, CMS will consider, where appropriate, state requests to retroactively amend or implement risk mitigation strategies only for the purposes of responding to the COVID-19 pandemic.

The information released today furthers CMS’s commitment to providing our state partners the resources they need during this public health emergency.  This and earlier CMS actions in response to the COVID-19 crisis are all part of ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, click here: www.coronavirus.gov. For a complete and updated list of CMS actions, guidance, and other information in response to the COVID-19 virus, please visit the Current Emergencies Website.  Additionally, CMS has launched a dedicated, Medicaid.gov, COVID-19 resource page that will be continually updated with relevant information.