Medicaid and CHIP Managed Care Final Rule: But wait, there is more

The Centers for Medicare & Medicaid Services (CMS) recently released an unpublished version of its mammoth Medicaid and Children’s Health Insurance Program Managed Care Access, Finance and Quality Final Rule (Final Rule). In a previous client alert, we analyzed the Final Rule’s principal changes to state-directed payments. In this alert, we address additional highlights from the Final Rule, including standards for timely access to care, in lieu of services and settings (ILOSs), medical loss ratio (MLR) and a new quality ratings system for Medicaid and CHIP managed care plans. The Final Rule does not make significant changes to the proposed version regarding many of the areas identified below but solidifies the desire to continue to address common issues of concern across the nation regarding access to care and ways to address other social determinants of health. However, whether states will oblige with the additional funds and resources necessary to implement many of these changes is a question, depending upon which geographic area of the country Medicaid beneficiaries and providers sit.

The Final Rule is scheduled for Federal Register publication on May 10, 2024. The regulations in the Final Rule will become effective July 9, 2024. Table 1 of the Final Rule sets out “Applicability dates” for regulatory changes other than the effective date.

Source: Medicaid and CHIP Managed Care Final Rule: But wait, there is more / Norton Rose Fulbright

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