Newly proposed regulations governing Medicaid managed care plans across the nation have been published this week with a comment period lasting through July 27, 2015. These proposals are not yet in effect and are likely to be modified after the comment period. They focus on key protections needed for covered recipients and program integrity safeguards. As governmental payors increasingly transition to managed care plans from fee-for-service funding models, we are likely to see continued regulation of plan criteria on the State and Federal level.
Bond’s Managed Care legal support team will be providing focused reviews of each area covered in the 658 page CMS issuance over the course of the next 45 days to assist clients seeking to comment on the proposed regulations.
The extensive revisions proposed by CMS seek to modernize the Medicaid managed care regulations to reflect changes in the usage of managed care delivery systems – especially the expansion into specialized service areas and long term services and supports. Themes also include:
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aligning the rules governing Medicaid managed care with those of other major sources of coverage such as Medicare Advantage plans;
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strengthening actuarially sound payment provisions
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promoting the quality of care and strengthen efforts to reform delivery systems that serve Medicaid and CHIP beneficiaries
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ensuring appropriate beneficiary protections
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enhancing policies related to program integrity and subcontracting by plans
The unpublished version of the proposed regulations are available at the following link: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-12965.pdf.
