The Centers for Medicare & Medicaid Services issued two final rules April 22 related to access to care within Medicaid managed care and fee-for-service plans.
The American Dental Association previously sent letters in June 2023 to CMS, commenting on both rules after they were proposed and offering suggestions.
Below are key takeaways from the final rules.
MANAGED CARE
State Medicaid programs have been expanding their use of managed care as an alternative service delivery and payment system to traditional fee-for-service systems. Managed care organizations are health plans that contract with states to provide comprehensive Medicaid benefits to enrolled beneficiaries. The state Medicaid agency pays the managed care organization a set amount of money per patient to cover the expected cost of health care services for that patient over a certain period of time.
Source: What to know about new Medicaid rules addressing access to care / ADA News