Medspan’s Tri-Weekly Newsletter–See What We Have Learned and You Should Know

Changes to Managed Medicaid In May 2015, the Center for Medicare and Medicaid Services (CMS) released a 653-page rule that is likely to create the largest changes in managed Medicaid in over ten years. Most importantly, the proposed rule would: Cap insurer benefits by requiring that managed Medicaid plans use 85 cents of each premium dollar to cover medical care. Require states to more meticulously oversee the adequacy of managed Medicaid plans’ provider networks. Encourage states to establish quality rating programs for plans. Allow more behavioral healthcare in institutional settings. Encourage the growth of managed long-term care. Approximately 46 million Americans, or 75% of all Medicaid beneficiaries, are in managed-care plans. That number is rising rapidly through state initiatives to control costs and ACA’s expansion of Medicaid to low-income adults (pending King vs. Burwell). The millions of children covered under the Comprehensive Health Insurance Plan (CHIP) also would be affected by the proposed rule. When structuring their provider networks, managed Medicaid plans would have more specific time and distance standards for certain types of providers: hospitals, primary care physicians and OB-Gyns. Time and distance standards more accurately address access to care than the current measure of enrolee-to-provider ratios. It is unclear as to how states that are struggling financially may respond to the proposed rule. Source: Dickson, V., & Herman, B. (2015, May 30). New CMS rule could reshape Medicaid managed care. Retrieved June 15, 2015.

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