The Centers for Medicare &
Medicaid Services (“CMS”) published its proposed rule to update its standards
and requirements for Medicaid managed care plans.
CMS notes that laws passed since the
Medicaid managed care regulations were promulgated in 2002 have changed
Medicaid to such an extent that the current regulations are no longer adequate.
Accordingly, the proposed rule addresses many issues in order to bring the
regulatory scheme in line with these changes, including: modernizing the
Medicaid managed care regulations to reflect changes in the usage of managed
care delivery systems; aligning the rules governing Medicaid managed care with
those of other major sources of coverage, including coverage through qualified
Health Plans and Medicare Advantage plans; implementing statutory provisions; strengthening
the actuarial soundness of payment provisions to promote the accountability of
Medicaid managed care program rates; promoting the quality of care; strengthening
efforts to reform delivery systems that serve Medicaid and Children’s’ Health
Insurance Program (“CHIP”) beneficiaries; ensuring appropriate beneficiary
protections and enhance policies related to program integrity; requiring states
to establish comprehensive quality strategies for their Medicaid and CHIP
programs regardless of how services are provided to beneficiaries; implementing
provisions of the Children’s Health Insurance Program Reauthorization Act of
2009; and, addressing third party liability for trauma codes. See Proposed
rule, 80
FR 31098, June 1, 2015, for further information.
If you have any questions or concerns, please feel free to contact Meghan McNab at mmcnab@kdlegal.com.