AHA to CMS re: Proposed Rule: Medicaid and Children’s Health Insurance Plan (CHIP) Managed Care

The AHA has supported CMS’s efforts over the last several years to modernize the Medicaid managed care regulations to more closely align with the Medicare Advantage program as well as private insurance. In general, AHA believes these efforts have helped promote a more accountable and transparent process for how state Medicaid capitation rates are established and how health plan premium dollars are spent. They have included policies to standardize requirements for the state capitation rate setting process and health plan medical loss ratios, provider network adequacy standards, strategies for quality improvement, and increased flexibility for managed care payment for care that individuals receive in Institutions for Mental Diseases. This proposed rule is intended to build on these current efforts to grant state Medicaid agencies greater flexibility to tailor their Medicaid managed care programs to meet the needs of their populations as well as address state agencies’ concerns regarding administrative burden. While the AHA generally supports CMS’s efforts to grant greater state-level flexibility and reduce regulatory burden, we do believe the agency needs to strike the appropriate balance between federal standards and state flexibility to ensure Medicaid enrollees have timely access to quality care services. AHA’s more detailed comments regarding the proposed rule appear in the PDF below.

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