CMS soon to release new Medicaid managed care regulations
- CMS plans to release an undisclosed proposal in the next few weeks that will overhaul the Medicaid managed care marketplace. Guidelines have not been updated since 2002.
- The regulations have been under review at the Office of Management and Budget since March. HHS described the proposal in its spring 2014 regulatory agenda as aligning Medicaid managed-care regulations with existing commercial, marketplace, and Medicare Advantage regulations.
- Since states can tailor their managed care plans, there can be conflicting regulations. The new proposal is intended to bring consistency to state and private plans and government programs.
Since Medicaid managed care regulations were last updated in 2002, John Gorman, executive chairman and founder of the Gorman Health Group told Bloomberg BNA that "this is literally the biggest healthcare regulation in a dozen years." The scope here is significant: Of the 70 million Medicaid beneficiaries in the U.S., 40 million are in managed-care plans.
What should the industry expect to see in the proposal? A couple things: A recent Kaiser Family Foundation brief predicted that information access would be the agency's chief concern, suggesting that CMS might require MCOs and states to make plan information available online and report accessibility measures with people with disabilities. The agency will also likely tighten up the rules for network adequacy, provider availability and provider directories, KFF suggests.
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