CMS to release numerous proposed or final rules by 2016

By January 2016, CMS plans to release numerous new proposed or final rules affecting many key aspects of the $540 billion Medicaid program. The planned new federal policies are significant, with far reaching implications for state Medicaid agencies, health plans, providers, and beneficiaries. CMS and other federal agencies are under pressure to promulgate rules before the end of the Obama Administration, hence the ambitious schedule. The rules themselves will be a mix of substantial new policies, regulatory cleanup, and codification of CMS policies lacking regulatory authority, and remaining changes from the Affordable Care Act.

The recently published CMS proposed rule on Medicaid managed care is a prime example. In the document’s 184,940 words, CMS proposes dozens of dramatic new requirements and processes for states and Medicaid managed care organizations of all types. Public comments are due July 27, with a final rule expected in early 2016.

Other major proposed or final rules CMS is planning to release include:

  • Medicaid Supplemental Payments: In November 2015, CMS plans to relate a major proposed rule governing state use of Medicaid supplemental payments. CMS is expected to propose rule-level requirements regarding distribution of supplemental payments, performance measures in supplemental payment programs, and significant new data collection and quarterly reporting by states. CMS also seeks to place a time limit on Medicaid supplemental payments.
  • Methods for Assuring Access to Covered Medicaid Services: By October 2015, CMS plans to release its final rule setting “standardized, transparent process” state Medicaid agencies must follow in meeting the requirements of section 1902(a)(30)(A) of the Social Security Act. This tortuous statute requires states to ensure that Medicaid payments are efficient and economical and support quality of care as well as sufficient to ensure adequate provider participation in each geographic area. The final rule will also create a web-based option for states to communicate State Plan Amendments (SPAs) and alert the public to rate changes.
  • Long Term Care Facility Requirements: This proposed rule is designed to modernize requirements nursing homes must meet to participate in Medicare and Medicaid. Affecting both skilled nursing facilities and nursing facilities, it will expand expectations for quality of care and patient safety, while removing some outdated requirements. The White House Office of Management and Budget (OMB) is reviewing CMS’ proposed rule now and publication with a 60-day comment period is expected soon.
  • Medicaid Income Eligibility: In a proposed rule scheduled for August 2015, CMS will release a large list of post-ACA changes to rules affecting Medicaid income eligibility, post-eligibility treatment of income, and handling of premium support.
  • Medicaid Eligibility Notices, Fair Hearings, and Appeal Processes: Following CMS’ January 2013 proposed rule, this final rule – expected in August 2015 – will set in regulations the many new beneficiary rights and related processes states must follow.
  • Medicaid Outpatient Drugs: The Affordable Care Act made several changes to Medicaid drug coverage and Medicaid drug rebates. CMS expects to publish the final rule in August 2015. The proposed rule was back in 2012.
  • Mental Health Parity: CMS’ final rule applying the 2008 federal mental health party law to Medicaid managed care plans is scheduled for January 2016.
  • PACE Programs: CMS plans to “overhaul” the Program of All-inclusive Care for the Elderly (PACE) to modernize existing regulations, provide new operational flexibility for PACE programs, and remove redundancies and outdated information. The proposed rule is slatted for September 2015.


About Kip Piper

Kip Piper, Senior Consultant, has a wealth of public healthcare experience, both at federal and state levels.Kip is a nationally recognized authority on Medicare, Medicaid, and health reform. He has advised business and government leaders on health finance and policy, coverage, reimbursement, legislative and regulatory issues, public affairs, strategic communications, and business development. Kip has served as Senior
Adviser to the Administrator of the Centers for Medicare and Medicaid Services, as Wisconsin State Health Administrator, as Director of the Wisconsin Medicaid program, as a Senior Health Financing Examiner for the White House Office of Management and Budget, Vice President of AcademyHealth, Corporate Officer at WellPoint, and director of major foundation-sponsored projects on quality improvement and pay-for-performance (P4P).