For the first time in over 12 years, CMS released proposed revisions to Medicaid Managed Care regulations earlier this summer. CMS aims to modernize Medicaid Managed Care by accomplishing two primary goals:
- Improve beneficiary experience.
- Alignment of Medicaid Managed Care with other healthcare coverage programs such as Medicare and Marketplace.
Most notably, the proposed rule speaks to Managed Long Term Services and Supports (MLTSS), acknowledging the significant uptick in the inclusion of beneficiaries using LTSS in Medicaid Managed Care.
LeadingAge submitted comments on the proposed revisions, including protecting the ability for an enrollee to dis-enroll from a plan (outside of annual enrollment) if their residential or institutional provider is no longer in network; and providing states the ability to direct some aspects of health plan contracting with providers, such as setting a floor for rates, requiring annual percentage increases or developing reimbursement models that align payment with quality.
Certain provisions are still a concern, with LeadingAge recommended the following revisions:
- Providing states with increased flexibility to designate counties as rural and, therefore, waive the requirement of a choice of at least two health plans.
- Allowing health plans to retain any unspent funds supplied by the state for provider incentive programs.
(Jill Sumner, LeadingAge)