CMS issues proposed rule for Medicaid, CHIP managed care plans

The Centers for Medicare & Medicaid Services late today released a proposed rule that would update Medicaid and Children’s Health Insurance Program managed care regulations to better align them with existing commercial, Marketplace and Medicare Advantage regulations. The proposed rule, which is the first major update to Medicaid and CHIP managed care regulations in more than a decade, includes updates to managed care provider networks, quality measures, external quality review, and beneficiary rights and protections. In addition, CMS proposes to add new requirements for medical loss ratios for managed care plans, implement best practices identified in existing managed long-term care services and support programs, require states to develop a Medicaid managed care quality rating system for health plans, and permit managed care flexibility for enrollees aged 21 to 64 in short-term inpatient or sub-acute institutions for mental disease. For more information, see the CMS factsheet. AHA members will receive a Special Bulletin on Wednesday with more information.