Healthcare Innovation September 9, 2025
CMS sets timeline for Medicaid SDP payment reductions and compliance
Key Highlights
- CMS’s guidance sets new payment limits for SDPs in Medicaid managed care, starting July 4, 2025.
- Inpatient, outpatient, and practitioner services must not exceed 100 percent or 110 percent of Medicare rates, depending on state expansion status.
- Eligible SDPs submitted before July 4, 2025, may qualify for grandfathering until January 1, 2028, after which phased reductions will occur.
- States are required to revise non-compliant SDP preprints to align with new federal requirements.
- This initiative aims to hold states accountable and ensure federal funds are used appropriately under the One Big Beautiful Bill Act.
On Tuesday, September 9, the Centers for Medicare & Medicaid Services (CMS) announced...
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