On Tuesday, September 9, the Facilities for Medicare & Medicaid Companies (CMS) introduced that it’s issuing preliminary steerage for states concerning the implementation of recent federal cost limits for State Directed Funds (SDPs) in Medicaid managed care. In accordance with the information launch, offering this steerage now, whereas CMS works to concern a closing rule, offers states extra time to plan their efforts to fulfill the necessities set out within the One Large Lovely Invoice Act.
“Underneath Medicaid managed care, states can direct how managed care plans pay suppliers via SDPs,” the press transient defined.
“Medicaid is a federal and state partnership and for years states have skirted their obligations to attract down extra federal funds whereas contributing much less state {dollars}. President Trump’s One Large Lovely Invoice Act will maintain states accountable and ensure the federal authorities isn’t left to select up the tab,” Well being and Human Companies (HHS) Secretary Robert F. Kennedy, Jr. stated in a press release.
CMS supplied a steerage letter with info on the diminished cost, particulars on eligibility for a short lived grandfather interval, and extra subsequent steps.
Key components of the steerage had been outlined as follows:
- Beginning with score intervals on or after July 4, 2025, SDPs for inpatient hospital companies, outpatient hospital companies, nursing facility companies, and certified practitioner companies at an educational medical middle should not exceed one hundred pc of Medicare charges in Medicaid growth states or 110 % of Medicare charges in non-expansion states.
- Sure eligible SDPs submitted or authorised earlier than July 4, 2025, could qualify for momentary grandfathering till score intervals starting January 1, 2028, adopted by a phased discount till they meet the brand new cost limits.
- States should revise any pending or future SDP preprints that don’t qualify for grandfathering to adjust to Part 71116 earlier than CMS continues its evaluate.
