Proposed Medicaid rule: 7 things health execs should know
The Centers for Medicare & Medicaid Services (CMS) proposed to modernize Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations to update the programs’ rules and strengthen the delivery of quality care for beneficiaries. This proposed rule is the first major update to Medicaid and CHIP managed care regulations in more than 10 years.
The Centers for Medicare & Medicaid Services (CMS) proposed to modernize Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations to update the programs’ rules and strengthen the delivery of quality care for beneficiaries. This
“CMS is proposing rules that would bring Medicaid plans more in line with the rules governing Medicare Advantage and commercial health insurance markets following tremendous growth for more than two decades,” says Ash Shehata, U.S. Health Plans Advisory Leader at
An overarching theme to this proposal, among others that have come from CMS, is a push toward value-based payments in healthcare, according to Shehata.
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These new rules are intended to address a number of issues that have built up over time in Medicaid managed care, according to Managed Healthcare Executive Editorial Advisor Don Hall, former health plan CEO and currently principal,
“The growth in Medicaid managed care members has soared with the implementation of [the Affordable Care Act] and has pushed CMS to take a hard look at how to best address member and plan concerns,” Hall says. “These new rules will put a great deal of pressure on health plan executives to deliver measurably better outcomes in quality, member experience and efficiency. It will also require state Medicaid agencies to be much more transparent in rate setting.”
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