The Academy Advisors conducted a series of interviews with members in Q2 of 2025 with the goal of documenting and organizing best practices and lessons to share in advocacy related to State Directed Payment Programs (SDPs) and the tax structures that support them, such as provider assessments, which have recently come under intense scrutiny.

This report organizes the information shared in those interviews and offers analysis of recent proposals introduced in Congress and through rulemaking at the Centers for Medicare and Medicaid Services (CMS) that would reform regulations governing SDPs and the types of taxes states can levy to fund them.