HHS Issues Final Rule to Overhaul Managed Medicaid

In the first overhaul of managed care in Medicaid and the Children’s Health Insurance Program (CHIP), the Department of Health and Human Services (HHS) issued a final rule in an effort to deliver better care, smarter spending and healthier people. The rule will affect Medicaid managed care plans and the beneficiaries enrolled in them, including low-income children and families, pregnant women, elderly and individuals with disabilities.

The final rule has four goals:

1. supporting states’ efforts to advance delivery system reform and improvements in quality of care for Medicaid and CHIP beneficiaries;
2. strengthening the consumer experience of care and key consumer projections;
3. strengthening program integrity by improving accountability and transparency; and
4. aligning rules across health insurance coverage programs to improve efficiency and help consumers who are transitioning between sources of coverage. In addition, the rule establishes Medicaid’s first Quality Rating System and clarifies states’ authority to enter into contracts that pay plans for quality or encourage participation in alternative payment models and other delivery system reform efforts. And, it establishes network adequacy standards in Medicaid and CHIP managed care for key types of providers, while leaving states flexibility to set the actual standards.

Provisions of the rule will be implemented in phases over the next three years, starting on July 1, 2017. More information about the rule can be found at www.medicaid. gov/medicaid-chip-program-information/by-topics/delivery-systems/managed-care/managed-care-site.html.