Statement on Medicaid Managed Care Rule

Tom Nickels
Executive Vice President
American Hospital Association

April 25, 2016

The Centers for Medicare & Medicaid Services (CMS) today issued Medicaid managed care regulations that represent the first major update to this program in more than a decade. These changes attempt to bring Medicaid managed care programs in closer alignment with Medicare Advantage and private insurance, particularly private insurance sold in the Health Insurance Marketplaces.

The new requirements include access and coverage protections for the patients that hospitals serve. For example, states will be required to set standards to ensure patients have adequate access to doctors and other providers, and will require insurers to frequently update their provider directories.

We are pleased that adult patients will now have greater access to psychiatric health services, including the ability to receive care in an inpatient psychiatric hospital or facility providing short-term crisis residential services.

We are disappointed that CMS will no longer allow supplemental payments in managed care plans, although a 10-year transition period will be helpful to hospitals as we continue to care for vulnerable patients.

About the AHA

The AHA is a not-for-profit association of health care provider organizations and individuals that are committed to the health improvement of their communities. The AHA is the national advocate for its members, which include nearly 5,000 hospitals, health care systems, networks, other providers of care and 43,000 individual members. Founded in 1898, the AHA provides education for health care leaders and is a source of information on health care issues and trends. For more information, visit the AHA website at www.aha.org.