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.
CMS reported that the Medicaid managed care rule had four key goals:
- 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.