Briefs & Reports

CMS Releases Sweeping Managed Care Rules

On May 26, 2015, the federal Centers for Medicare and Medicaid Services (CMS) released a proposed managed care rule intended to update and strengthen the Medicaid and Children’s Health Insurance Program (CHIP) regulations last updated in 2003. “This proposed rule would modernize the Medicaid managed care regulations to reflect changes in the usage of managed care delivery systems. The proposed rule would align the rules governing Medicaid managed care with those of other major sources of coverage, including coverage through Qualified Health Plans and Medicare Advantage plans; implement statutory provisions; strengthen actuarial soundness payment provisions to promote the accountability of Medicaid managed care program rates; and promote the quality of care and strengthen efforts to reform delivery systems that serve Medicaid and CHIP beneficiaries. It would also ensure appropriate beneficiary protections and enhance policies related to program integrity. This proposed rule would also require states to establish comprehensive quality strategies for their Medicaid and CHIP programs regardless of how services are provided to beneficiaries. This proposed rule would also implement provisions of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) and addresses third party liability for trauma codes.”

CMS also published several two or three-page briefs describing key features or goals of the proposed rules, including “Improving the Beneficiary Experience”, “Quality Improvement”, “Program and Fiscal Integrity Improvement and Alignment”, “Strengthening the Delivery of Managed Long Term Services and Supports”, “Alignment with Medicare Advantage and Private Coverage Plans”, and “Strengthening States’ Delivery System Reform Efforts”. These documents are available on the CMS website.

Comments on the proposed rule are due by 5:00 pm Eastern Daylight Time on July 27, 2015.

For more information, contact Esther Reagan, Senior Consultant, at (517) 482-9236.