MLTSS Primer on Medicaid Provider Payment Pathways During COVID-19

On May 14, 2020, CMS provided guidance through its informational bulletin Medicaid Managed Care Options in Responding to COVID-19 on how states and managed care plans can use existing regulatory and sub-regulatory guidance to assist providers. 1 The May 2020 document primarily seeks to clarify permissible actions by states related to Medicaid managed care plan payments to providers during the public health emergency. The document also provides additional clarifications on actions plans may voluntarily take in support of their provider networks.

The goal of this primer is to inform relevant stakeholders (e.g. managed care organizations, state Medicaid programs, and relevant Medicaid providers) on the regulatory framework of the provider payment methodologies included in the May 2020 document and to serve as a reference tool during efforts to implement those methodologies. The May 2020 document outlines CMS’s rationale on two provider payment methodologies – Advanced Payments and Retainer Payments – and their use in the managed care context. Additionally, it provides considerations for how these methodologies may be administered by states and plans.

Read the full primer here.