CMS proposes changes to managed Medicaid, CHIP: 7 things to know

CMS issued a proposed rule Nov. eight geared toward overhauling its 2016 controlled care rules for Medicaid and the Youngsters’s Well being Insurance coverage Program.

Listed here are seven issues to understand:

1. Underneath controlled care techniques, states contract with non-public well being insurers to manage Medicaid and CHIP plans. In 2016, greater than two-thirds of Medicaid beneficiaries had been in a controlled care plan, and states are proceeding to make bigger their use of controlled care contracts.

2. CMS mentioned it labored with the Nationwide Affiliation of Medicaid Administrators and state Medicaid administrators to check and analyze present rules. Their proposed adjustments intention to create extra flexibility and goal provisions that states and stakeholders mentioned are pricey and burdensome.

three. A number of the proposals, CMS mentioned it’s going to let states broaden and certify a charge vary, so long as it meets explicit prerequisites. It’s going to additionally supply states a three-year transitional duration to agree to pass-through cost necessities. Go-through bills are what the federal government can pay Medicaid controlled care plans along with their base capitation charge, and the plans should go bills to gotten smaller suppliers.

four. The rule of thumb proposes giving states extra flexibility to set community adequacy requirements that may come with telehealth products and services.

five. CMS additionally mentioned it’s going to attempt to transfer states via their federal charge evaluate procedure sooner by way of permitting states to put up much less documentation in some cases. It’s going to additionally let states tailor another High quality Ranking Gadget, whilst requiring states to fulfill a minimal set of obligatory measures.

6. CMS proposed prohibiting states from retroactively including or enhancing risk-sharing mechanisms.

7. Whilst CMS isn’t proposing any adjustments to its limitation of 15 days on lengths of keep for controlled care beneficiaries in an establishment for psychological illness, it said states’ fear that this rule poses administrative burdens.

For the overall proposal, click on right here.

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Oklahoma circle of relatives wins $15M agreement over denied Aetna protection
How the ‘large five’ payers fared in Q3


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