On April 27, 2023, CMS released a notice of proposed rulemaking, Medicaid Program; Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality. The proposed rules, which were published in the Federal Register on May 3, adopt new standards for access to care for services delivered through a managed care model, as well as new and enhanced requirements related to program quality and finance.
READ THE FULL SUMMARY
CMS accepted public comment on the proposed rulemaking through July 3, 2023.
Sellers Dorsey summarized the comments made by state agencies, health plans, hospitals and stakeholders. Our report summarizes everything you need to know on comments relating to:
- Access – enrollee experience surveys, appointment wait time standard, secret shopper surveys, transparency, and more
- State Directed Payments – definitions, Medicare exemption, SDP standards, non-network providers, submission timeframes, value-based payments and more
- Medical Loss Ratio Standards – provider incentives, prohibited costs in quality improvement activities, reporting resubmission requirements, and more
- In Lieu of Services and Settings – general parameters, enrollee rights, state monitoring
- Quality Assessment and Performance Improvement Program, State Quality Strategies and External Quality Review
- Quality Improvement – Quality Rating System – mandatory measure set, MAC QRS methodology, MAC QRS website display
READ THE PROPOSED RULE COMMENT SUMMARY
Sellers Dorsey experts hosted a webinar discussing the implications of the proposed rule as well as key considerations for states, managed care plans, and others in the healthcare industry. They shared insights regarding impacts on access, quality and financing for Medicaid managed care programs, and so much more.
