On May 26th, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (available here) on managed care in Medicaid and the Children’s Health Insurance Program (CHIP). The proposed rule would align the rules governing Medicaid managed care with those of other major sources of coverage, including coverage through Qualified Health Plans (QHP) and Medicare Advantage plans; clarify rate-setting methodologies for plans and providers; and strengthen efforts to reform delivery systems that serve Medicaid and CHIP beneficiaries. This proposed rule is the first major update to Medicaid and CHIP managed care regulations in over a decade.
SPG’s summary of this rule can be found here. Comments will be accepted until July 27, 2015.