The 2016 managed care rule created a new option, referred to as directed payments, that allows states to require managed care plans to pay providers according to specified rates and methods. To examine how states are using this option, MACPAC contracted with Mathematica to review available information on approved directed payments and to interview state officials and stakeholders in five states (California, Florida, Massachusetts, Ohio, and Utah).
This presentation reviewed themes that emerged about the relationship between fee-for-service) supplemental payments and directed payments, as well as the large share of Medicaid payments that directed payments represent for certain providers. It also examined the substantial growth in directed payments in the absence of an upper limit, noting also that the effects of directed payments on quality and access are unclear in many cases. Finally, staff discussed oversight challenges. The presentation concluded with a discussion of potential policy approaches for Commissioner consideration.
