Virgil Dickson | February 19, 2016
The CMS has sent a sweeping finalized rule that will overhaul the managed Medicaid program to the Office of Management and Budget for review.
The 653-page proposed version of the rule suggested the biggest changes in Medicaid managed-care regulations in more than a decade. It would cap insurer profits, require states to more rigorously supervise the adequacy of plans’ provider networks, encourage states to establish quality rating systems for plans, allow more behavioral healthcare in institutional settings and encourage the growth of managed long-term care.
The OMB review can take up to 90 days, which means the final rule could be published by mid-to late May, a year after it was proposed.
The proposed rule received nearly 900 comments by the July 27 comment deadline.
Some states have been waiting in dread for the final rules to be released. Indiana’s Medicaid director Joe Moser admitted during a National Association of Medicaid Directors last fall that his department had suggested the CMS drop the rule in its entirety.
“It’s another 600 plus pages of regulations that we don’t think is actually going to help this population,” Moser said. “It’s unfunded mandates, more work for our staff. It’s the federal government dictating to states how they should run their programs.”
Thirty-nine states and the District of Columbia outsource their Medicaid programs by paying fixed, monthly sums to private managed-care plans, yielding $115 billion in revenue for insurers and $2.4 billion in operating profits last year, according to data compiled by Mark Farrah Associates and analyzed by Kaiser Health News.
About 46 million people, or 73% of all regular Medicaid beneficiaries, are in managed-care plans, and that figure will continue to rise through the Affordable Care Act’s expansion of Medicaid to low-income adults, according to consulting firm Avalere Health. Millions of kids in the Children’s Health Insurance Program are also in managed care and would be covered by the proposed rule.
Source: Modern Healthcare
http://www.modernhealthcare.com/article/20160219/NEWS/160219886