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LeadingAge New York Seeks Comments from Members on Proposed Federal Medicaid Managed Care Regulations

LeadingAge New York is seeking comments from members on comprehensive Medicaid managed care regulations recently proposed by the Centers for Medicare and Medicaid services (CMS).  The proposed regulations would apply to mainstream managed care, managed long term care, and the Medicaid component of FIDA and MAP.  They would govern a broad array of managed care operational, financial, beneficiary protection, and compliance issues.  Key provisions would:

  • Apply the federal home and community-based setting  and person-centered planning standards to services covered by Medicaid managed care plans;
  • Establish standards for setting actuarially-sound rates, including the use of a medical loss ratio of 85%;
  • Require accreditation or similar certification of Medicaid managed care plans;
  • Require the enrollment of all managed care network providers in the Medicaid program;
  • Require states to provide Medicaid beneficiaries with at least 14 days to select a plan and to make available fee-for-service benefits in the interim;
  • Require enrollees to exhaust one level of internal appeal before seeking a fair hearing and shorten the deadline for plans to respond to an appeal from 45 to 30 days;
  • Expand the definition of rural to exempt additional regions from the requirement that a choice of two managed care plans be available; and
  • Permit states to direct plans to use state-specified value-based payment methodologies when contracting with providers and to align payment methods with multi-payer payment initiatives.

A high-level summary of the proposed regulations is available here; a more detailed outline is available here.

LeadingAge New York members are asked to submit any comments on the proposed rule to Karen Lipson, by July 20.  Please use the format of the summary matrix if possible.  Members that would like to submit comments directly to CMS may do so by 5:00 p.m. on July 27 by going to http://www.regulations.gov and following the ‘‘Submit a comment’’ instructions.

Contact:  Karen Lipson, klipson@leadingageny.org, (518) 867-8383 ext. 124.