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State Directed Payments in Medicaid Managed Care

As the HHS agency overseeing Medicaid, CMS issued regulations establishing certain circumstances under which States may direct managed-care payments to providers. These payments are referred to as State directed payments. While working within Federal parameters, States determine criteria for providers to receive these directed payments. For selected State directed payments in Medicaid managed care, our objective is to determine whether the State: (1) obtained CMS approval for the directed payment proposal, (2) complied with CMS-approved requirements and outcomes in the approved proposal, and (3) ensured that directed payments were made according to the approved proposal.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
July 2024 Centers for Medicare and Medicaid Services State Directed Payments in Medicaid Managed Care Office of Audit Services WA-24-0056 (W-00-24-31580) 2025