Capitol Correspondence - 11.10.20

CMS Issues Managed Care Rule

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As announced by the Centers for Medicare and Medicaid Services:

“The Centers for Medicare & Medicaid Services (CMS) released the 2020 Medicaid & Children’s Health Insurance Program (CHIP) Managed Care final rule that helps to streamline the Medicaid and CHIP managed care regulatory framework,  reduce unnecessary and duplicative administrative burdens and further reduces federal regulatory barriers to help ensure that states are able to work efficiently and effectively to design, develop, and implement Medicaid and CHIP managed care programs that best meet each state’s local needs. 

In 2016, the Medicaid & CHIP Managed Care Rule was updated for the first time in more than a decade.  After the 2016 updates, CMS continued to hear from stakeholders that the regulations were overly prescriptive and burdensome. Thus, CMS formed a working group with the National Association of Medicaid Directors (NAMD) and State Medicaid Directors to review and prioritize areas of concern within the managed care regulations. The recommendations from this group culminated in the proposals that CMS put forward for public comment in November 2018.  This final rule strengthens provisions in the 2016 rule taking into consideration the comments we received, giving states greater flexibility to establish appropriate payment for Medicaid and CHIP services and to set standards that reflect the geographic realities of their state. 

By streamlining managed care regulations, this final rule supports state efforts to advance delivery system reform and improve quality of care, strengthens care and protections for children and adults with Medicaid and CHIP, reinforces program integrity by improving accountability and transparency, and aligns key Medicaid and CHIP managed care requirements with other health coverage programs.

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