CMS proposes updated Medicaid, CHIP-managed care regulations

CMS recently proposed a rule to update managed care regulations for Medicaid and the Children’s Health Insurance Program, according to a press release.

The recommended adjustments reflect the growth of managed care — a health care delivery system that organizes cost, utilization and quality to participants enrolled in Medicare, Medicaid and private insurance markets, according to CMS. Medicaid’s managed care regulations have not been revised since 2003. In addition, the regulations would target broader populations receiving managed care, including seniors and patients with disabilities.

“A lot has changed in terms of best practices and the delivery of important health services in the managed care field over the last decade,” Andy Slavitt, MBA, acting administrator of CMS, said in the release. “This proposal will better align regulations and best practices to other health insurance programs, including the private market and Medicare Advantage plans, to strengthen federal and state efforts at providing quality, coordinated care to millions of Americans with Medicaid or CHIP insurance coverage.”

According to the release, CMS plans to:

  • support state reformation efforts for delivery systems within managed care programs;
  • improve quality of care by strengthening transparency, creating a quality rating system and engaging consumers and stakeholders;
  • improve beneficiary experience, including enrollment, communication, care coordination and access to covered services;
  • apply the best practices established in managed long-term services and support programs;
  • align Medicaid policies to Medicare Advantage and private market policies;
  • strengthen Medicaid’s fiscal and programmatic integrity; and
  • align CHIP-managed care regulations with the revised Medicaid managed care rules.

CMS recently proposed a rule to update managed care regulations for Medicaid and the Children’s Health Insurance Program, according to a press release.

The recommended adjustments reflect the growth of managed care — a health care delivery system that organizes cost, utilization and quality to participants enrolled in Medicare, Medicaid and private insurance markets, according to CMS. Medicaid’s managed care regulations have not been revised since 2003. In addition, the regulations would target broader populations receiving managed care, including seniors and patients with disabilities.

“A lot has changed in terms of best practices and the delivery of important health services in the managed care field over the last decade,” Andy Slavitt, MBA, acting administrator of CMS, said in the release. “This proposal will better align regulations and best practices to other health insurance programs, including the private market and Medicare Advantage plans, to strengthen federal and state efforts at providing quality, coordinated care to millions of Americans with Medicaid or CHIP insurance coverage.”

According to the release, CMS plans to:

  • support state reformation efforts for delivery systems within managed care programs;
  • improve quality of care by strengthening transparency, creating a quality rating system and engaging consumers and stakeholders;
  • improve beneficiary experience, including enrollment, communication, care coordination and access to covered services;
  • apply the best practices established in managed long-term services and support programs;
  • align Medicaid policies to Medicare Advantage and private market policies;
  • strengthen Medicaid’s fiscal and programmatic integrity; and
  • align CHIP-managed care regulations with the revised Medicaid managed care rules.