CMS proposes first major update to Medicaid and CHIP managed care regulations
Today, the Centers for Medicare & Medicaid Services (CMS) proposed to modernize Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations to update the programs’ rules and strengthen the delivery of quality care for beneficiaries. This proposed rule is the first major update to Medicaid and CHIP managed care regulations in more than a decade. It would improve beneficiary communications and access, provide new program integrity tools, support state efforts to deliver higher quality care in a cost-effective way, and better align Medicaid and CHIP managed care rules and practices with other sources of health insurance coverage. Overall, this proposed rule supports the agency’s mission of better care, smarter spending, and healthier people.
“A lot has changed in terms of best practices and the delivery of important health services in the managed care field over the last decade. This proposal will better align regulations and best practices to other health insurance programs, including the private market and Medicare Advantage plans, to strengthen federal and state efforts at providing quality, coordinated care to millions of Americans with Medicaid or CHIP insurance coverage,” said Andy Slavitt, Acting Administrator of CMS.
Since CMS last issued managed care regulations in 2002 and 2003, the health care delivery landscape has changed and grown substantially. States have expanded managed care to several new populations including seniors and persons with disabilities. The growth of managed care in the Marketplace and Medicare Advantage further highlights the importance of policy alignment when appropriate across programs in order to ease the transition for consumers whose circumstances change during the year.
CMS proposes to modernize Medicaid managed care regulations in the following ways:
• Supporting states’ efforts to encourage delivery system reform initiatives within managed care programs that aim to improve health care outcomes and beneficiary experience while controlling costs; and
• Strengthening the quality of care provided to beneficiaries by strengthening transparency and measurement, establishing a quality rating system, and broadening state quality strategies and consumer and stakeholder engagement;
• Improving consumer experience in the areas of enrollment, communications, care coordination, and the availability and accessibility of covered services;
• Implementing best practices identified in existing managed long term services and supports programs;
• Aligning Medicaid managed care policies to a much greater extent with those of Medicare Advantage and the private market;
• Strengthening the fiscal and programmatic integrity of Medicaid managed care programs and rate setting;
• Aligning the CHIP managed care regulations with many of the proposed revisions to the Medicaid managed care rules strengthen quality and access in CHIP managed care programs.
For a summary of this proposed rule, please visit the CMS fact sheet.