Medicaid Managed Care Regulations Get Update

After more than a decade, Medicaid and the Children's Health Insurance Program (CHIP) managed care payment regulations are getting an update. The Centers for Medicare and Medicaid Services (CMS) announced a proposed rule in late May, addressing:

• beneficiary communication and access,
• program integrity and actuarial soundness requirements,
• quality and cost eective health care delivery,
• and alignment of Medicaid and CHIP managed care with other payer sources to ease patients' transitions between health care programs.

"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," Acting CMS Administrator Andy Slavitt said in a press release announcing the proposal.

The proposed rule was published in the June 1, 2015 Federal Register. The deadline for public comments is July 27, 2015. CMS has also provided a Fact Sheet on its website summarizing the provisions of the proposed rule.

Takeaway: The government's focus on quality and costeffectiveness continues with an update to Medicaid and CHIP managed care regulation to align policies and protect beneficiaries.