Posts

CMS Proposes New Medicaid Managed Care Regulation

Just two years after a major overhaul of Medicaid managed care regulations, the Centers for Medicare & Medicaid Services is again proposing changes in how the federal government regulates the delivery of managed care services to Medicaid beneficiaries.

Under the newly proposed regulation, states would:

  • be free to implement more changes in their managed care programs without seeking federal permission;
  • have slightly more flexibility in how supplemental payments are made to hospitals through managed care plans and implement some such changes without federal approval;
  • be permitted to redefine what constitutes an adequate provider network for managed care plans; and
  • not be required to publicize beneficiary grievance and appeals processes as prominently as they currently do.

Overall, the proposed regulation appears to help managed care insurers a great deal, states a little, and hospitals barely at all.  It also could have serious implications for private safety-net hospitals, most of which are located in states that employ managed care in their Medicaid programs.

Stakeholders have until January 14 to submit formal comments about the proposal to CMS.

To learn more about the proposed Medicaid managed care regulation, go here to see CMS’s news release presenting the regulation, go here to see a more detailed CMS fact sheet, and go here to see the proposed regulation itself.

New Rules Facilitate Integration of Physical, Behavioral Care

New federal regulations are facilitating better integration of physical and behavioral health services for the Medicaid population.

Two developments, in particular, are advancing this integration:  the 2016 Medicare managed care rule and a 2016 rule implementing the Mental Health Parity and Addiction Equity Act of 2008.  Together, these rules encourage providers to perform comprehensive assessments of their patients, increase flexibility for providers in how they use Medicaid payments, and pave the way for improvements in the use of information technology that foster better integration of physical and behavioral medical care.

A new issue brief from the Commonwealth Fund presents in greater detail how these new regulations, in combination with other legislation and regulations, are facilitating a more integrated approach to the delivery of physical and behavioral care to the Medicaid managed care population.  Go here to see the brief “Assessing Changes to Medicaid Managed Care Regulations: Facilitating Integration of Physical and Behavioral Health Care.”

Medicaid Directors Comment on Proposed Medicaid Pass-Through Regulation

national association of medicaid directorsLast November the Centers for Medicare & Medicaid Services proposed a new regulation governing the use of pass-through payments in state Medicaid managed care programs.

The National Association of Medicaid Directors submitted formal comments to CMS about that proposed regulation. See its comments here.

See NAUH’s comments on the same proposed regulation here.