CMS NEWS
FOR IMMEDIATE RELEASE
May 26,
2015
Contact: CMS Media Relations
(202) 690-6145 | CMS
Media Inquiries
CMS
proposes rule to strengthen managed care for Medicaid and CHIP Enrollees
Proposal
will modernize and improve quality of care for Medicaid and CHIP managed care
plans
Today, the Centers for
Medicare & Medicaid Services (CMS) proposed to modernize Medicaid and
Children’s Health Insurance Program (CHIP) managed care regulations to update
the programs’ rules and strengthen the delivery of quality care for
beneficiaries. This proposed rule is the first major update to Medicaid and
CHIP managed care regulations in more than a decade. It would improve
beneficiary communications and access, provide new program integrity tools,
support state efforts to deliver higher quality care in a cost-effective way,
and better align Medicaid and CHIP managed care rules and practices with other
sources of health insurance coverage. Overall, this proposed rule supports the
agency’s mission of better care, smarter spending, and healthier people.
“A lot has changed in terms of best
practices and the delivery of important health services in the managed care
field over the last decade. This proposal will better align regulations and
best practices to other health insurance programs, including the private market
and Medicare Advantage plans, to strengthen federal and state efforts at
providing quality, coordinated care to millions of Americans with Medicaid or
CHIP insurance coverage,” said Andy Slavitt, Acting Administrator of CMS.
Since CMS last issued managed care
regulations in 2002 and 2003, the health care delivery landscape has changed
and grown substantially. States have expanded managed care to several new
populations including seniors and persons with disabilities. The growth of
managed care in the Marketplace and Medicare Advantage further highlights the
importance of policy alignment when appropriate across programs in order to
ease the transition for consumers whose circumstances change during the year.
CMS proposes to modernize Medicaid managed
care regulations in the following ways:
·
Supporting
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; and
·
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.
The proposed rule is available at https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-12965.pdf
or https://www.federalregister.gov/public-inspection
and can be viewed at https://www.federalregister.gov/articles/2015/06/01/2015-12965/medicaid-and-childrens-health-insurance-program-chip-programs-medicaid-managed-care-chip-delivered
starting June 1. The deadline to
submit comments is July 27, 2015.
For more information, visit http://medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/managed-care/managed-care-site.html.
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