Data / Federal rules / 2026-10292
Medicaid Program; Medicaid Managed Care State Directed Payments and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments
The Centers for Medicare & Medicaid Services published this proposed rule in the Federal Register on May 22, 2026. Comments closed on July 21, 2026.
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What the agency says
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)(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. This rule also proposes to set a limit for certain targeted Medicaid payments in Medicaid fee-for-service. We propose this change based on our 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.
Key facts
- Document number
- 2026-10292
- Type
- Proposed rule
- Action
- Proposed rule
- Agency
- Health and Human Services Department; Centers for Medicare & Medicaid Services
- Published
- May 22, 2026
- Comments due
- July 21, 2026
- Dates
- To be assured consideration, comments must be received at one of the addresses provided below, by July 21, 2026.
- Docket
- CMS-2449-P
- Regulation ID (RIN)
- 0938-AV69
- Code of Federal Regulations
- 42 CFR 438; 42 CFR 447
- Topics
- Accounting; Administrative practice and procedure; Citizenship and naturalization; Civil rights; Drugs; Grant programs-health; Health facilities; Health professions; Individuals with disabilities; Medicaid; Reporting and recordkeeping requirements; Rural areas; Sex discrimination
- Significant
- Yes, under Executive Order 12866
- Pages
- 67
Other documents from the Centers for Medicare & Medicaid Services
Everything from the Centers for Medicare & Medicaid Services · Rules on accounting · Rules on administrative practice and procedure · Rules on citizenship and naturalization · Published in May 2026
Read from the Federal Register API, last updated 2026-10-23. The document on federalregister.gov is the official record; dates and dockets can change through later corrections. Free to reuse with credit to SpecStream under CC BY 4.0.