Source: AAFP Washington, DC, Office
On April 25, the Centers for Medicare & Medicaid Services (CMS) released the long awaited final rule to align Medicaid and the Children’s Health Insurance Program (CHIP) managed care plans with other health insurance rules.
- Supporting states’ efforts to advance delivery system reform and improvements in quality of care for Medicaid and CHIP beneficiaries
- Strengthening the consumer experience of care and key consumer projections
- Strengthening program integrity by improving accountability and transparency
- Aligning rules across health insurance coverage programs to improve efficiency and help consumers who are transitioning between sources of coverage.
The rule sets a minimum medical loss ratio for Medicaid of 85%, creates a Medicaid managed care quality rating system, and ensures network adequacy. The American Academy of Family Physicians sent CMS a letter commenting on the regulation last summer. The AAFP Government Relations staff is reviewing the regulation and will be updating members on important changes.