LeadingAge submitted comments to the Centers for Medicare and Medicaid Services (CMS) on July 20, 2026, regarding a proposed rule,  CMS-2449-P: Medicaid Program; Medicaid Managed Care State Directed Payments (SDPs) and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments, to limit Medicaid state directed payments, as required by HR 1. The comments urged CMS to align rulemaking with the enabling statute and withdraw the rule’s expansions in scope.