Comment on CMS-2026-1916-0001
Anonymous AnonymousOtherIndividual
Summary: The commenter is seeking clarification regarding the timing and requirements for "written prior approval" for State directed payments. They are specifically asking whether approval must be obtained before implementation and how Managed Care Organizations should proceed if a request is submitted but approval is still pending.
Section 438.6(c)(2)(i) requires “written prior approval” for certain State directed payments but does not specify the event to which “prior” refers. The preamble indicates that approval is expected prior to implementation of the SDP.
Given this, can CMS clarify whether “prior approval” is intended to require approval prior to implementation of the SDP, including MCO payment of the SDP? In addition, can CMS clarify expectations for MCOs where an SDP has been timely submitted prior to the start date but CMS approval is still pending, including whether payments may proceed during this period or should be delayed until written approval is obtained?