Health policy organization KFF on June 27 published an analysis of documents states submit to the Centers for Medicare and Medicaid Services (CMS) when seeking approval for state directed payments in managed care and the potential impact of text in the Senate version of the budget reconciliation package.

Currently, the language would cap states’ use of directed payments (SDPs) at Medicare payment rates for Medicaid expansion states and 110% of Medicare rates in non-expansion states. States typically are not involved in setting the payment rates negotiated between managed care companies and providers in Medicaid managed care. When states do get involved and mandate payments, these are SDPs. Multiple states use benchmarks that reference the average commercial rate (ACR) which can be double or triple typical Medicaid payments for a service.

The analysis describes which states are most at risk of seeing rate reductions based on possible enactment of the Senate’s released reconciliation text. KFF does not parse the data between risks to hospitals and nursing homes, possibly because of the structures of the CMS form.

Read the analysis here.

LeadingAge continues to have concerns about how limitations in payments across the healthcare system will destabilize access to care and healthcare affordability.

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