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CMS Finalizes CHIP/Medicaid Managed Care Rule

The Centers for Medicare and Medicaid Services (CMS) is scheduled to publish a final Medicaid managed care rule titled "Medicaid Program; Medicaid and Children’s Health Insurance Program (CHIP) Managed Care" [CMS-2408-F] on Nov. 13th. The rule finalizes provisions of the rule proposed in November 2018 and marks the first major changes to the regulations since 2016. The regulations were informed by a working group that CMS formed with the National Association of Medicaid Directors (NAMD) and state Medicaid directors to prioritize areas of concern.

The rule provides greater flexibility in certain circumstances to states regarding pass-through payments when transitioning populations to managed care and allows states to require plans to adopt payment models based on a state plan-approved fee-for-service fee schedule without written approval from CMS. The rule also seeks to align quality measurements, facilitates greater beneficiary information, provides states with greater flexibility to set network adequacy standards, and prohibits states from adding or modifying risk-sharing mechanisms after the start of the rating period.

Most of the provisions of the rule are effective 30 days after publication. Until the rule is published on Nov. 13th, a preview version of the full text is available here. A CMS Fact Sheet is available here.

LeadingAge NY Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841