CMS issues new Medicaid managed care rules for comment

May 26, 2015
Area(s) of Interest: Payor Issues and Reimbursement Practice Management Public Payors 

The Centers for Medicare and Medicaid Services (CMS) has issued new Medicaid managed care federal regulations for the first time since 2002. Indications from those who have already commented on agency drafts are that the new rules will address rate setting, stronger beneficiary protections and easing beneficiary transitions between Medicaid managed care organizations, Medicare Advantage plans and marketplace qualified health plans.

The new rules will also address managed care for long-term care for the first time. As baby boomers age, long-term managed care is widely recognized as one of the toughest coming challenges for the U.S. health care system – and Medicaid managed long-term care will provide a unique challenge for states.

The new rules are rumored to potentially address provider network adequacy, with an emphasis on ensuring plan directories are accurate along with better protections for beneficiary protections, both issues the California Medical Association (CMA) has continuously advocated for on the national and state levels.

CMA will continue to track these regulations and anticipates providing comments. You can read the new rules here.


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