CMS releases final rule on Medicaid, CHIP managed care

The Centers for Medicare & Medicaid Services today finalized a 2018 proposed rule implementing policy changes recommended by state Medicaid directors and others to streamline managed care regulations for the Medicaid and Children’s Health Insurance Program. Among specific changes, the rule gives state Medicaid agencies greater flexibility to tailor their managed care programs to the needs of their populations and address concerns regarding administrative burden.

The rule also permits states transitioning Medicaid populations or services from fee-for-service to managed care to require managed care plans to make pass-through payments to providers for up to three-years; and states to require plans to adopt directed provider payment models based on a state plan-approved fee-for-service fee schedule without written approval from CMS and approve multi-year payment arrangements that meet certain criteria. The rule would permit beneficiary access to electronic provider directories, and better align Medicaid quality program with other CMS quality measurement initiatives, but AHA has concerns that the final rule no longer requires states to set time and distance standards for network adequacy and will allow states to set quantitative network adequacy standards. AHA members will receive a Special Bulletin this week with more details.