Author: Simon Barr

CMS Releases New Oversight Rules for Medicaid State-Directed Payments

CMS has released new guidance tightening federal oversight of Medicaid state-directed payments (SDPs) in managed care. The update centers on transparency, documentation, and measurable quality outcomes—signaling stronger guardrails on financing, distribution methodologies, and alignment with actuarial soundness and value-based care. Payers, providers, and state agencies should prepare for enhanced monitoring and reporting expectations.

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Real-Time Drug Price Transparency Coming for U.S. Consumers

HHS has finalized a rule (HTI-4) to deliver real-time prescription drug price transparency at the point of care, giving clinicians and consumers visibility into patient-specific coverage, out-of-pocket costs, and prior authorization requirements through certified health IT. The move aims to reduce administrative burden, speed access to therapy, and support more cost-effective prescribing aligned with value-based care goals.

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