Lloyd A. Bookman

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311 appearances 1 recordings 1 series first heard Jul 2026 last heard 17 Jul

Lloyd A. Bookman’s voice in public audio — every appearance, attributed to the second.

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AHLA's Speaking of Health Law · One Year In: Implementing the Medicaid Provisions of the Working Families Tax Cut Act · 17 Jul 2026 podcast

uh are grandfathered from this limitation until january one twenty twenty eight.

Um and then the and then their state directed payment pots have to be reduced by ten percent annually until you get down to the um either hundred percent or hundred and ten percent uh Medicare limit.

Um this rule applies to hospitals, nursing facilities, academic medical centers, and CBO estimated 149 billion savings over 10 years.

But then we get the proposed rule that came out on May twenty twenty sixth.

That provides um uh some heartburn to a lot of states and providers.

Uh one thing it does it extends these caps.

to beyond state directed payments to fee for service payments made on a targeted basis to different classes of providers.

So the the Medicare limits will now apply to those payments.

Secondly

It reaches all provider types on state directed payments, not just the you know, not just hospitals, not just nurse uh hospitals, academic medical centers and the

Well.

provider types that were subject to HR one, but it extends it to virtually any kind of provider type.

So that that's an expansion that wasn't in the statute.

CMS said we think this is just something we can do and we're going to do it.

But here's the the one of the big questions on the Medicare limits on state directed payments is how are you gonna compute that?

How you can apply the Medicare limit?

Um we have for those of you who are in this area, there's the UPL, the upper payment limit, on the fee for service side of the world.

That's uh also a Medicare limit, but it's computed in the aggregate.

Will the state's aggregate spending under Medicaid be under what it would have spent under Medicare rules in the aggregate?

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