Health Affairs January 16, 2020
Edwin Park

On November 18, the Centers for Medicare and Medicaid Services (CMS) issued a proposed “Fiscal Accountability” rule which could significantly change how states finance their share of the cost of Medicaid programs and how states provide supplemental payments to hospitals, nursing homes, physicians and other providers.  The CMS rule has garnered only limited attention, with the Administration primarily portraying the rule as increasing the transparency of Medicaid supplemental payments as has been previously recommended by the Medicaid and CHIP Payment and Access Commission (MACPAC) and the Government Accountability Office (GAO).  But less well understood is the extensive reach of the proposed rule and how it seriously threatens longstanding and widely used financing and payment arrangements in most states.   Despite its likely broad, harmful impact, CMS acknowledges in the...