CMS Proposed Rule on Medicaid Managed Care Plans

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 According to the May 26 notice, CMS is updating its rules on Medicaid managed care plans, since the last rule was issued 13 years ago. The proposed rule applies to both Medicaid and the Children’s Health Insurance Program. 

A preliminary read suggests CMS is looking at the following areas that could apply to the long-term services and supports field:

  • Adequacy of provider networks, of interest because so-called “skinny networks” may exclude the nursing home that a Medicaid recipient calls home.
  • More freedom for beneficiaries to change plans which could be helpful if a beneficiary’s nursing home or home care provider falls out of the beneficiary’s managed care network.
  • More transparency in the way states set Medicaid reimbursement rates – we will argue that most states reimburse long-term services and supports providers far below the actual cost of services.
  • Guidelines on medical loss ratios – we will urge CMS to take into account the non-medical long-term services and supports typically covered by Medicaid. Expenses like transportation for home care workers are not “medical” but they are essential to the provision of services covered under the program. Unlike Medicare and regular health insurance plans that cover only medical services, managed Medicaid plans have to factor in these kinds of costs.

(Barbara Gay, LeadingAge)


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