Capitol Correspondence - 07.17.17

CMS Issues Bulletin on Medicaid Managed Care Rule Compliance

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On June 30, the Centers for Medicare and Medicaid Services (CMS) released an information bulletin to states regarding compliance with the Medicaid managed care final rule. The bulletin says that CMS believes some of the new rules are potentially burdensome to states, and so intends to use its enforcement discretion to work with states to implement state-specific compliance solutions, based on state needs and circumstances. If a state is interested in taking advantage of CMS’ enforcement flexibility, the state will need to identify to their regional office the particular regulation(s) that they will be unable to implement by the mandated compliance date. Once identified, CMS will then work with the state to assess compliance with those regulations in the following ways:

  • The specific goals and intent for the regulation;
  • Compliance with regulatory standards that were in effect prior to the Medicaid managed care rule publication in 2016;
  • Alternatives the state could consider in moving toward compliance and strategies for how states can best mitigate specific risks and concerns with non-compliance; and, 
  • Developing a timeline for future compliance with the regulatory requirement.

CMS notes that additional flexibility is not available for actuarial soundness and payment provisions, the pass-through payment provisions, or the medical loss ratio provisions found in the rule.