CMS Releases Landmark Final Rule for Medicaid Managed Care
Centers for Medicare & Medicaid Services has proposed a revival in Medicaid and Children’s Health Insurance Program managed care regulations. The final rule that was published on May 10, 2024, in the Federal Register established a compliance date of July 9, 2024. This rule aims to bolster the regulatory provisions to improve access to care, quality and health outcomes, and equity for enrollees.
This rule recognized the growing significance of managed care in Medicaid and CHIP as there was an increase in the percentage of enrolment from 81% in 2016 to 85% in 2021. Current estimates show that 74.6 % of Medicaid beneficiaries are already enrolled in comprehensive managed care organizations.
The final rule introduces a range of new standards and requirements, including:
- Appointment Wait Times: New standards for maximum wait times for appointments, ensuring timely access to care.
- Secret Shopper Surveys: Mandatory use of secret shopper surveys to assess the availability and accessibility of services.
- Enrollee Experience Surveys: Implementation of enrollee experience surveys to gather feedback on the quality of care.
- Network Adequacy Monitoring: States must submit a managed care plan analysis of provider payments to monitor network adequacy, ensuring sufficient access to healthcare providers.
Although the final rule is effective on July 9, 2024, some provisions have different applicability dates. Some of the requirements will be effective 60 days after the publication and the others will be phased in over the next six years. The final rule represents the new standard for Medicaid and CHIP-managed care programs. States and managed care organizations will be required to adjust their management to align with the more stringent demand.
Investments in provider networks and enhanced moving health needs will likely be primary. Other changes that may be expected are an improved process of appointment scheduling, sectoral reasoning, and a better patient-facing procedure. Similarly, the knowledge of patient experience and feedback from different states and managed care organizations will be widely shared.
Source:
- https://www.lexology.com/library/detail.aspx?g=62aa8e0e-7122-4490-bbb8-8d295248e7bc
- https://www.jdsupra.com/legalnews/cms-managed-care-final-rule-aims-to-3300092/