As we reported several days ago, the State Executive Budget proposes significant changes to the current fiscal intermediary structure. The State recently published a summary of the Executive’s Proposal and, in relation to fiscal intermediaries, the summary states: “There are currently over 500 fiscal intermediaries receiving differing levels of reimbursement for providing various administrative and payroll services to self-directing Medicaid recipients receiving personal care. The Executive Budget seeks to consolidate and establish uniform reimbursement for these services.” The reference to consolidation could mean that the State proposes to force all currently operating fiscal intermediaries to meet one of the newly proposed definitions of fiscal intermediary (see our previous alert, where we discussed the proposed new definition for fiscal intermediaries).