CMS recently proposed regulations regarding Medicaid managed care. The proposed rule, which was released on June 1, offers the fist major update to Medicaid and CHIP managed care regulations since 2002 – in many ways, this update and modernization of the regulations is overdue. In general, the proposal takes a big step toward aligning Medicaid and CHIP managed care requirements with those already in place for qualified health plans (marketplace plans) and Medicare advantage plans. The proposed regulations also:
- Establish standards for plan network adequacy
- Create new beneficiary protections, especially for vulnerable populations
- Establish a medical loss ratio (MLR) for plans
- Require greater transparency in capitation rate setting
- Create a new framework for quality improvement
- Change the way in which plans can pay for short-term stay in institutions for mental disease (IMDs)
- Give states flexibility in designing and administering managed long term services and supports (LTSS)
- Provide opportunities for states and plans to work together toward innovative payment and delivery reforms
Earlier this month, Vorys Health Care Advisors President Maureen M. Corcoran and Vorys health care Partner Suzanne J. Scrutton co-hosted a well-attended webinar about key provisions of the proposed regulations. The webinar focused on the following areas of interest:
- What and who is covered by the rule
- Financial considerations
- Implications for access and quality of services
- Key regulatory issues
Webinar attendees included a wide variety of health care professionals working in the areas of behavioral health, developmental disabilities, children with special needs, and long-term services and support.
A full copy of the webinar slides is available for download. Questions and comments about the webinar and its content can still be submitted to Maureen at MMCorcoran@VorysHCAdvisors.com and to Suzanne at SJScrutton@Vorys.com.