Skip to content Skip to navigation

CMS proposes changes to Medicaid managed care regulations

May 26, 2015
by Lois A. Bowers, Senior Editor
| Reprints

The Centers for Medicare & Medicaid Services (CMS) has revisited its regulations related to Medicaid managed care for the first time in more than a decade and is proposing several changes (PDF) that it says will modernize them and improve quality in the delivery of care to beneficiaries.

The 653-page proposal will be published in the Federal Register on June 1. CMS will accept comments on the changes until July 27.

“A lot has changed in terms of best practices and the delivery of important health services in the managed care field over the last decade,” Andy Slavitt, acting administrator of CMS, said in a statement. “This proposal will better align regulations and best practices to other health insurance programs, including the private market and Medicare Advantage plans, to strengthen federal and state efforts at providing quality, coordinated care to millions of Americans.”

CMS says the proposed changes will:

  • Support states’ efforts to reform delivery systems within managed care programs to improve healthcare outcomes and the beneficiary experience while controlling costs.
  • Strengthen the measurement of quality, establish a quality rating system and broaden state quality strategies as well as consumer and stakeholder engagement.
  • Improve the consumer experience related to enrollment, communications, care coordination and the availability and accessibility of covered services.
  • Implement best practices identified in existing managed long-term services and supports programs.
  • Align Medicaid managed care policies to a much greater extent with those of plans in Medicare Advantage and the private market.
  • Strengthen the fiscal and programmatic integrity of Medicaid managed care programs and rate-setting.

The government most recently issued managed care regulations in 2002 and 2003. Since then, states have expanded managed care to several new populations including seniors and those with disabilities. The prevalence of managed care also has grown in the Marketplace and Medicare Advantage plans.

CMS also announced proposed changes to the managed care regulations for its Children’s Health Insurance Program, or CHIP.