State Phased-Down Billing

State Phased-Down Billing
SPOTLIGHT & RELEASES
09/19/2024: CMS released the CY 2024 (Oct-Dec) Phased-Down State Contribution Rates & CY 2025 (Jan-Sep) Phased-Down State Contribution Rates. More information can be found below.

 

The Medicare Prescription Drug Improvement and Modernization Act of 2003 (Medicare Modernization Act or
MMA) established the Medicare Part D prescription drug benefit effective January 2006. At that time, Medicare
became the primary payer for most prescription drugs for full-benefit dually eligible beneficiaries. However,
the MMA established the phased-down state contribution process, in which states are responsible for making
monthly payments to CMS, representing a portion of the expenditures for beneficiaries whose Medicaid drug coverage has been assumed by Medicare Part D.

The 2021 version of the State Phased-Down (SPD) Billing Guide (PDF) updates information and instructions for states on operations concerning the state phased-down contribution process, including:

  • Relationship between state reporting and the SPD contribution amount
  • SPD Contribution Billing
  • State Itemized Liability Report
  • Offset Against State Medicaid Grant Award
  • Methods States May Use to Pay the SPD Contribution Amount
  • Fedwire Procedures
  • Pay.gov

Send an email to DPBCStateBuy-in@cms.hhs.gov for SPD contribution billing inquiries and requests.

Phased-Down State Contribution Per Capita Rates

CY 2025 Quarters 1-3 (Jan-Sep) Phased-Down State Contribution Rates Memorandum (PDF)

CY 2024 Quarter 4 (Oct-Dec) Phased-Down State Contribution Rates Memorandum (PDF)

CY 2024 Quarters 1-3 (Jan-Sep) Phased-Down State Contribution Rates Memorandum (PDF)


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Page Last Modified:
10/07/2024 04:08 PM