Use and Oversight of Directed Payments in Medicaid Managed Care

In 2016, the Centers for Medicare & Medicaid Services finalized a comprehensive update of managed care regulations, which included a new option allowing states to direct payments to providers as part of delivery system and provider payment initiatives. This presentation examines state use of directed payments, noting that of the 121 directed payment arrangements approved as of June 2019, 76 percent are state-directed fee schedules and 24 percent direct MCOs to participate in value-based payment arrangements. The presentation also describes the Commission’s ongoing work to better understand approaches to promote the use of value-based payment in managed care and potential areas for future work.