CMS’ Sweeping Medicaid Managed Care Rules Set New Quality Standards
The long-awaited regulation, the biggest for Medicaid managed care in a decade, changes many aspects of how large insurance contractors who administer care for some of the most vulnerable patients.
Modern Healthcare:
85% Medical-Loss Ratio In Final Managed Medicaid Rule
The CMS has finalized a long-awaited rule that will overhaul managed Medicaid, which has not been updated in a decade. The sweeping 1,425-page rule, which was proposed last May, caps insurer profits, requires states to more rigorously supervise the adequacy of plans' provider networks, encourages states to establish quality rating systems for plans, allows more behavioral healthcare in institutional settings and promotes the growth of managed long-term care. But the CMS deferred to state control for several issues. (Dickson and Herman, 4/25)
Kaiser Health News:
Administration Says New Rules For Medicaid Plans Will Improve Service For Enrollees
The Obama administration tightened rules Monday for private insurance plans that administer most Medicaid benefits for the poor, limiting profits, easing enrollment and requiring minimum levels of participating doctors. For consumers the most visible change may eventually be quality ratings intended to reflect Medicaid plans’ health results and customer experiences. The administration agreed to move slowly on such a sensitive industry issue, saying it would develop the scores over several years. (Hancock, 4/26)
The Associated Press:
Feds Issue New Standards For Medicaid Insurance Plans
The Obama administration Monday set new standards for Medicaid private insurance plans, which in recent years have become the main source of coverage for low-income people. The rules apply to insurers operating as Medicaid middlemen in 39 states and Washington, DC. Each state runs its own program, although the federal government pays most of the cost. Private insurers now provide coverage to about two-thirds of the more than 70 million Medicaid recipients, and the rules had not been updated for more than 10 years. (Alonso-Zaldivar, 4/25)
The Hill:
Obama Administration Issues Sweeping New Medicaid Regulation
The regulation updates rules concerning what is known as Medicaid managed care, where states contract with private health insurers to provide benefits to low-income people through Medicaid, a system that has grown in recent years to 39 states and two thirds of enrollees. The final rule, issued Monday, imposes requirements on how much of insurers revenue must go towards paying medical costs, as opposed to administrative costs or profits. (Sullivan, 4/25)
Morning Consult:
Long-Awaited Managed Care Rules For Medicaid, CHIP Are Final
Medicaid managed care services are offered by risk-based managed care organizations, which contract with state Medicaid programs to offer care to enrollees. Essentially, they are the private insurer alternative to traditional fee-for-service Medicaid. CMS hasn’t issued any new regulations to the program since 2002, but a lot has changed since then. Not only has the Medicaid program itself grown under the Affordable Care Act, but now about 80 percent of Medicaid enrollees are served through managed care delivery systems, according to CMS. (Owens, 4/25)
CQ Healthbeat:
Medicaid Rule Requires Health Plans To Meet Financial Standards
Health insurers that participate in Medicaid will have to spend a minimum amount of the money they receive on medical care, under a new Centers for Medicare and Medicaid Services rule released late Monday. (Evans, 4/25)
