CMS Releases Sweeping Rules For Private Medicaid Plans

Kaiser Health News: ‘Milestone’ Rules Would Limit Profits, Score Quality For Medicaid Plans
Sweeping proposals disclosed Tuesday would create profit guidelines for private Medicaid plans as well as new standards for the plans’ doctor and hospital networks and rules to coordinate Medicaid insurance more closely with other coverage. “We are taking steps to align how these programs work,” said Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services, which proposed the rules. Privatized Medicaid has grown rapidly as budget-pinched states have responded to commercial insurers’ promise to deliver care for a fixed price. Most beneficiaries of Medicaid — state programs for the poor run partly with federal dollars — now get care through contracted insurers. (Hancock, 5/26)

Document: Download 653-Page Rule (PDF)

National Journal: The Obama Administration’s New Medicaid Rule Has Health Plans Fuming
The Centers for Medicare and Medicaid Services unveiled reams of proposed managed care rules for the low-income insurance program; this is the first time that the agency is revising the regulations since 2002. They cover everything from network adequacy and beneficiary protections to long-term care, which is new ground for federal regulations. But managed care companies, private health plans that cover Medicaid enrollees while receiving a per-member payment from the government, had been bracing for one proposal in particular: Medical-loss ratio. Medical-loss ratio says that health plans have to spend a certain percentage of money that they are paid on actual health care. (Scott, 5/26)

The Hill: Feds Unveil Long-Awaited Overhaul Of Medicaid Managed Care
The Centers for Medicare and Medicare Services (CMS) is proposing that Medicaid managed care groups align their standards with those in the private marketplace to create more uniform practices across states. Those changes will help to “ease the administrative burden on issuers and regulators” while also providing “an appropriate level of protection for enrollees,” CMS wrote in the rules. But the proposed rule is likely to draw fire from many of the 39 states that have enjoyed considered leeway in their own use of managed care. (Ferris, 5/26)

Bloomberg: U.S. Insurers Facing Tighter Oversight Of Medicaid Plans
The proposed rules, issued Tuesday by the Centers for Medicare & Medicaid Services, call for plans to report what portion of the money they’re paid actually gets spent on health benefits, and say states should take that into account when setting rates. The proposed guidance would also have states set standards for access to doctors and hospitals, and create a ratings system for plans. (Tracer, 5/26)

Modern Healthcare: Sweeping Medicaid Rule Targets Enrollment Boom In Private Plans
The CMS has released a sweeping proposed rule intended to modernize the regulation of Medicaid managed-care plans. Medicaid managed-care enrollment has soared by 48% to 46 million beneficiaries over the past four years, according to consulting firm Avalere. By the end of this year, Avalere estimates that 73% of Medicaid beneficiaries will receive services through managed-care plans. (Dickson, 5/26)

CQ Healthbeat: Medicaid Officials Release Long-Awaited Managed Care Rule
Medicaid plans would have to spend a minimal amount of their revenues on medical costs rather than administrative expenses, under a long-awaited proposal that federal Medicaid officials released Tuesday. The proposed rule would streamline regulations that were last updated in 2003. Since then, managed care plans have become grown to cover a rising portion of the Medicaid population, including an increasing number of people with long-term service needs or disabilities. (Adams, 5/26)