CMS Proposes Payments to Third Parties

Situation Report | August 16, 2021 

On August 2, 2021, the U.S. Centers for Medicare and Medicaid Services (CMS) proposed a rule which would enable states to make payments to third parties on behalf of certain individual health care practitioners, including home care workers and personal care assistants. According to CMS, these changes would make it easier for those workers to obtain and retain health insurance, training, and other employee benefits and would address the home care worker shortage. 

It proposes to allow Medicaid state agencies to make deductions from Medicaid payments due to certain individual practitioners in order to make payment to third parties on behalf of those practitioners for typical employee benefits, if the practitioner has consented to such deductions. This rule would apply to the class of individual practitioners for whom Medicaid is their primary source of revenue. 

This proposed rule would reinterpret the scope of the general requirement that state payments for Medicaid services under a state plan must be made directly to the individual practitioner providing services, in the case of a class of practitioners for which the Medicaid program is the primary source of revenue. Specifically, this proposal, if finalized, would explicitly authorize states to make payments to third parties to benefit individual practitioners by ensuring health and welfare benefits, training, and other benefits customary for employees, if the practitioner consents to such payments to third parties on the practitioner’s behalf.  

Review the proposed rule here.