New Rule Proposed for Medicaid and CHIP Enrollees

By Amanda Mattox

On May 26, 2015 the Centers for Medicare and Medicaid Services (CMS) proposed the following ways to modernize Medicaid Managed Care regulations:

  • Support States' efforts to encourage delivery system reform initiatives within managed care programs that aim to improve health care outcomes and beneficiary experience while controlling costs
  • Strengthening the quality of care provided to beneficiaries by strengthening transparency and measurement, establishing a quality rating system, and broadening state quality strategies and consumer and stakeholder engagement
  • Improving consumer experience in the areas of enrollment, communications, care coordination, and the availability and accessibility of covered services
  • Implementing best practices identified in existing managed long term services and supports programs
  • Aligning Medicaid managed care policies to a much greater extent with those of Medicare Advantage and the private market
  • Strengthening the fiscal and programmatic integrity of Medicaid managed care programs and rate setting
  • Aligning the CHIP managed care regulations with many of the proposed revisions to the Medicaid managed care rules strengthen quality and access in CHIP managed care programs

CMS last issued managed care regulations in 2002 and 2003 making this proposal the first major update to Medicaid and CHIP managed care regulations in more than a decade!  You may submit formal comments on the proposal by July 27, 2015.

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