On April 25th, the Centers for Medicare and Medicaid Services (CMS) issued a final rule on managed care in Medicaid and the Children’s Health Insurance Program (CHIP). The final rule aligns the rules governing Medicaid managed care with those of other major sources of coverage, including Qualified Health Plans and Medicare Advantage plans. The rule also clarifies rate setting methodologies for plans and providers and strengthens efforts to reform delivery systems that serve Medicaid and CHIP beneficiaries. The final rule is the first major update to Medicaid and CHIP managed care regulations in over a decade.
The attached document summarizes several major provisions of the final rule. The provisions of the final rule will be implemented over the next three years, starting in July 2016. The final rule is available here.