On November 12, CMS released an advance pre-publication copy of a Proposed Rule that would impose more stringent standards on Medicaid supplemental payments to providers. The goal of CMS is to “strengthen the fiscal integrity of the Medicaid program and help ensure that state supplemental payments and financing arrangements are transparent and value-driven,” in response to the steady increase of supplemental payments. The rule would improve reporting on supplemental payments, clarify Medicaid financing definitions, and reduce what CMS considers questionable financing mechanisms, including a state’s reliance on providers to fund the non-federal share, health care-related taxes and donations, and Medicaid DSH payments.