CMS Releases Proposed Rule: Medicaid and CHIP Managed Care Access, Finance, and Quality


The proposed rule would make transparency-related updates to state directed payments (SDPs). It would also require states to submit an annual payment analysis that compares managed care plans’ payment rates for routine primary care services, obstetrical and gynecological services, and outpatient mental health and substance use disorder services as a proportion of Medicare’s payment rates. The proposal would establish a framework for states to implement a Medicaid or Children’s Health Insurance Program (CHIP) quality rating system to create a “one-stop-shop” for enrollees to compare Medicaid or CHIP managed care plans based on quality of care, access to providers, covered benefits and drugs, cost and other plan performance indicators...

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