The Centers for Medicare & Medicaid Services issued a proposed rule on June 1, 2015 revising provisions of the Medicaid managed care program for the first time in over 12 years.
Here are six things to know:
1. CMS's changes will greatly impact Kentucky's Medicaid program with 90 percent of Kentucky's Medicaid beneficiaries on managed care plans as of 2011.
2. New CMS regulations will remove discrepancies between the Medicaid managed care program and other programs including Medicare Advantage.
3. The proposed rule removes the minimum medical loss exemption and requires managed care organizations, pre-paid inpatient health plans and pre-paid ambulatory health plans to meet a minimum medical loss ratio threshold of 85 percent.
4. The rule aims to improve the Medicaid beneficiary experience by providing beneficiary protection through managed care enrollment. This would protect more enrollees during the managed care organizations selection process.
5. The CMS proposed rule requires network adequacy and access standards similar to Health Exchange standards for Medicare Advantage plans to increase patient access to care.
6. Several goals of the new Medicaid managed include:
• Support state efforts to encourage delivery system reform initiatives with managed care systems.
• Strengthen the quality of care to beneficiaries by strengthening transparency and measurement, establishing a quality rating system and widening state quality strategies and stakeholder engagement.
• Align Medicaid managed care policies to a much great extent with those of Medicare Advantage and the private market.
• Enhance consumer experience in enrollment, communications, care coordination and the accessibility of covered services.
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