CMS proposes changes to Medicaid and CHIP managed care regulations

Nov 08, 2018 - 03:10 PM
CHIP-medicaid-update

The Centers for Medicare & Medicaid Services today issued a proposed rule that would streamline Medicaid and Children’s Health Insurance Program managed care regulations. 

The agency said today’s rule, which proposes changes to its 2016 final rule that was a comprehensive rewrite of Medicaid and CHIP managed care regulations, seeks to further reduce federal regulatory barriers to help ensure that state Medicaid and CHIP agencies can design, develop, and implement Medicaid and CHIP managed care programs that best meet each state’s local needs and populations. Many of the policy changes were recommendations made by a CMS working group that included the National Association of Medicaid Directors and individual state Medicaid directors.
Specifically, today’s rule proposes to:

  • Grant state Medicaid programs more flexibility in determining actuarially sound capitation rates for Medicaid managed care plans.
  • Permit states moving to Medicaid managed care to transition their Medicaid provider supplemental payments over a three-year period.
  • Grant states greater flexibility in directed payments to providers in managed care settings.
  • Replace the current provider network adequacy time and distance standard with a requirement that states establish quantitative network adequacy standards. 
  • Allow states to define adult and pediatric “specialists” for purposes of provider network adequacy standards.
  • Develop minimum mandatory performance measures to apply to federal Quality Rating Systems and alternative QRS standards.
  • Clarify that CMS will consult with states and other stakeholders in developing the federal QRS for Medicaid.
  • Apply the proposed provider network adequacy standards to CHIP.  

CMS does not propose changes to the current medical loss ratio requirements for Medicaid managed care plans or changes to the 15 day limit on lengths of stay for managed care beneficiaries in an institution for mental disease. 

CMS will accept comments on the proposed rule through Jan. 14. 

Related News Articles

Headline
CMS eliminates ‘fast-track’ process for certain Medicaid section 1115 waivers 
The Centers for Medicare & Medicaid Services July 7 released a bulletin announcing the end of its “fast-track” review process for certain Medicaid section…
Headline
AHA files amicus brief in case challenging HHS, CMS on provider taxes 
The AHA drafted and filed an amicus brief June 17 in the 5th U.S. Circuit Court of Appeals in a case regarding Medicaid financing and provider taxes filed by…
Headline
MACPAC recommends improvements to oversight of Medicaid managed care organizations
The Medicaid and CHIP Payment and Access Commission June 15 released its June 2026 report to Congress. Among the topics discussed, chapter two focuses on…
Headline
CMS issues interim final rule on Medicaid community engagement requirements 
The Centers for Medicare & Medicaid Services June 1 issued an interim final rule with comment period implementing the statutory requirement that certain…
Headline
CMS issues proposed rule on Medicaid supplemental payments
The Centers for Medicare & Medicaid Services May 20 released a proposed rule that would modify policies governing Medicaid state-directed…
Headline
HHS launches competition to support community care hubs working with health care providers 
The Department of Health and Human Services Administration for Community Living has launched the first phase of its Health at Home Challenge, a competition to…