Federal Medicaid Agency Issues Final Rule with Major Updates to Managed Care and Consumer Protections
The Centers for Medicaid and CHIP Services (CMCS) finalized “CMS-2390-P” on Monday April 25, 2016, which is a set of rules that will be published in the Federal Register soon.
The rule applies to health insurers operating Medicaid managed care plans for the states and it is the first major update to Medicaid and CHIP managed care regulations in more than a decade. It aligns key rules with those of other health insurance coverage programs; modernizes how states purchase Medicaid managed care services; and strengthens the consumer experience and key consumer protections.
As Families USA says in their news email, “The new rule is a big deal in part because it affects so many people: There are more than 72 million people enrolled in Medicaid. Three quarters of them are in managed care plans across 39 states. States can—and many already have—gone above and beyond these new standards in many areas. For other states, it will require substantial work to come into compliance. For many provisions (of the rule), CMS has given states (and managed care plans) a long implementation timeline.”
The final rule, when published, will be posted in the Federal Register: https://www.federalregister.gov/ It is currently available in PDF only, here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-09581.pdf
For more information on CMS-2390-P, a summary of its key provisions, guidance documents, technical assistance documents, and information about state managed care programs, visit the federal Medicaid Agency’s Managed Care website: https://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/managed-care/managed-care-site.html
Statements from the Centers for Medicare and Medicaid Services (CMS) and national organizations on CMS-2390-P
From the CMS Blog of April 25, 2016:
From the National Association of Medicaid Directors (NAMD):
Press Release April 26, 2016
NAMD Statement on Medicaid Managed Care Final Rule
From Families USA:
Families USA’s take on New Medicaid Managed Care Rules