CMS Issues New Guidance on Medicaid Managed Care Rule’s Application to IMDs

On August 18, the Centers for Medicare & Medicaid Services (CMS) released the second set of frequently asked questions (FAQs) for the Medicaid and CHIP Managed Care Final Rule. This guidance addresses common questions related to payments to managed care organizations (MCOs) and prepaid inpatient health plans (PIHPs) for an enrollee that is a patient in an institution for mental disease (IMD). The guidance clarifies the effective date of July 5, 2016 for impacted contracts. It further clarifies that capitation payments are allowed for an enrollee that was a patient in an IMD for more than 15 days that spans consecutive months when each stay was not more than 15 days in the month. The guidance provides additional information on the applicability of capitation payments under various short-term stay scenarios.

 

Additional guidance relating to the Managed Care rule is available here.