Updated CMS rule could significantly impact Medicaid managed care

April 09, 2016

CMS is expected to release of a final regulation on Managed Care in Medicaid and the CHIP program in the near future, possibly by May 1, Managed Healthcare Executive reports. This regulation will lead to major changes in Medicaid managed care programs; changes that focus on quality improvements, increased transparency and accountability, and strengthened state and federal oversight. While the draft text of the final rule is not yet public, a 2015 notice of proposed rulemaking established expectations that the final rule will contain significant program reforms. These include:

  • Strengthened beneficiary protections, such as standards for care management and choice counseling; and
  • Rules to ensure the adequacy of provider networks, and an increased focus on quality improvement.