Dive Brief:
- Last week, CMS sent its finalized "uber rule," which upgrades Medicaid managed care for the first time in over 10 years, to the Office of Management and Budget for review.
- The vast 653-page document proposes major changes including limits to insurer profits, heightened state supervision of provider network adequacy, and encouragement to states to institute quality rating systems for plans, notes Modern Healthcare.
- With the review to be completed within 90 days, the finalized rule could be expected to be published in May.
Dive Insight:
The proposed rule has been notably contentious--having received almost 900 comments during the comment period--for setting the medical loss ratio at 85%.
Although that provision is optional, critics worry if states comply it will destabilize programs eveloped at the state level, and they note that currrently, according to a CMS review of managed care plans, one in 10 had an MLR below 79% while one in four had one below 83%.
Jeff Myers, president and CEO of Medicaid Health Plans, told The Hill last May he had encouraged the agency not to follow through with the MLR hike, suggesting it was like a Swiss watch. "There are a lot of moving parts, but you know deep down, it's going to be very expensive," he said. The Interim CEO of AHIP, Dan Durham, had also voiced opposition to the provision.
The rule could improve access to behavioral healthcare services for Medicaid beneficiaries as the proposed rule would permit states to pay carriers for such services to beneficiaries for an in-patient stay of no more than 15 days at an institution for mental health.