Medicaid Managed Care Proposed Rule

Fri, 05/29/2015 - 16:20

CMS has submitted their 653 page proposed rule regarding Medicaid Managed Care. Certainly the provision garnering the greatest reaction to date is inclusion of an 85% medical loss ratio requirement for Medicaid plans. Some other issues addressed in the rule include increased provider network regulations, adding minimum time and distance standards that currently apply to just primary care or behavioral health, OB-GYNs and dentists, and having states provide greater transparency in rate determination.

Two healthsprocket lists have been posted regarding the proposed rule:
- Avalere Health: 6 provisions of Medicaid Managed Care Proposed Rule
- KHN: 5 Reasons Feds Are Overhauling Regs On Medicaid Outsourcing

The pre-publication pdf of the 653 page document is already available here, followed by the rule being published in the federal register on June 1st.

With regard to the scope of the impact of the proposed Rule, Avalere just issued a report, projecting by the end of 2015, 73 percent of Medicaid beneficiaries will receive services through managed care organizations, and they note "over the past four years, enrollment in Medicaid managed care has increased by 48 percent, with 46 million beneficiaries now receiving coverage through these plans."