CLV IntelligenceReimbursement Policy Monitoring

Alert detail

Medicaid Program; Medicaid Managed Care State Directed Payments and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments

Policy ID: 2026-10292Specialty: Medicare AdvantageAdded: 6/2/2026Effective: May 22, 2026federal rule
Low

What changed

Final Rule published 2026-05-22. This proposed rule describes alternatives to modify the limit on the total payment rate and other requirements for State directed payments in Medicaid managed care. We propose these changes based on our 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)(

Who’s affected: Medicare Advantage billing teams · Effective: May 22, 2026

Primary source: View the official CMS/MAC document ↗

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Medicaid Program; Medicaid Managed Care State Directed Payments and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments