CMS Proposes New Rules for Medicaid MCOs

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a proposal that would bring the rules governing Medicaid managed care plans into alignment with those for other private insurance and Medicare Advantage plans.

The proposed rule would also “implement statutory provisions; strengthen actuarial soundness payment provisions to promote the accountability of Medicaid managed care program rates; and promote the quality of care and strengthen efforts to reform delivery systems that serve Medicaid and CHIP beneficiaries. It would also ensure appropriate beneficiary protections and enhance policies related to program integrity. This proposed rule would also require states to establish comprehensive quality strategies for their Medicaid and CHIP programs regardless of how services are provided to beneficiaries.”

Like many other states, North Carolina is struggling with the future direction of its Medicaid program. Some in the General Assembly seek to outsource it to corporate managed care organizations as other states have done with mixed results. Other legislators and the McCrory administration are in favor of following the path endorsed by the North Carolina Medical Society (NCMS) and other stakeholders in the health care community of forming homegrown provider-led entities to assume the financial and operational risk of caring for our state’s most vulnerable citizens. In either instance, this new proposal generally strengthens patient protections and holds the managed care organizations to a higher financial standard for quality of care than previously required.

 
 

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