Medicaid Program; Medicaid Managed Care State Directed Payments and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments
Built by the Tribune's code from the Federal Register. No AI wrote this page. Published in the Federal Register May 22, 2026. Document 2026-10292. Updated Nov. 10, 2026.
- What it does
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.
The Centers for Medicare & Medicaid Services's summary, as published in the Federal Register.
- What it would change
2 parts of Title 42 of the Code of Federal Regulations:
- Before this
No earlier Federal Register document under regulation identifier 0938-AV69 since Jan. 1, 2025.
- What happens next and when
To be assured consideration, comments must be received at one of the addresses provided below, by July 21, 2026.
The agency's dates, word for word.
The record as published
| Document number | 2026-10292 |
|---|---|
| Action | Proposed rule. |
| Agencies | Health and Human Services Department; Centers for Medicare & Medicaid Services |
| Published | May 22, 2026 |
| Comments close | July 21, 2026 |
| Regulation identifier (RIN) | 0938-AV69 |
| Docket | CMS-2026-1916 |
| Significant (marked in the Federal Register) | Yes |
Source: the Federal Register (public domain). The document in the Federal Register