Impacts of the New Federal Medicaid Managed Care Rule

PHA Issue Brief on New MMC Rules
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Opportunities to Improve Access and Quality of Care for Medicaid Beneficiaries

The managed care delivery system has grown to be the primary model for delivering Medicaid services to approximately 75% of the Medicaid population, and it has been almost a decade since the last set of comprehensive managed care rules were released.

On April 22, 2024, CMS released for public inspection a final rule, Medicaid Program; Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality. Through these final rules, CMS seeks to promote consistency and transparency, focusing on improving access and driving quality for Medicaid beneficiaries served by managed care plans.

Our latest issue brief, created in collaboration with Population Health Alliance, aims to summarize key provisions within the 2024 final managed care rule and assess potential impacts and opportunities for states, MCOs, providers, and solution partners to meet the intended goal of improving access to and the quality of care for Medicaid enrollees.

Click here to download the issue brief, today.

Plus, explore more insights from Sellers Dorsey on the final managed care rule, including our recorded webinar.
Click here for more insights!

 

Leesa Allen
Before joining Sellers Dorsey, Leesa served as both the Executive Deputy Secretary for the Department of Human Services (DHS) and the Commonwealth’s Medicaid Director, and prior to that as the Deputy Secretary for Medical Assistance Programs and the former Executive Medicaid Director for the Commonwealth. In this most recent role, Leesa was responsible for providing direction and oversight for the Department’s 16,000 employees and $30 billion budget, including eligibility and enrollment services, child welfare services, long-term care services for the elderly and intellectually disabled populations, behavioral health services, program integrity, and the statewide administration and oversight of the $30 billion Medicaid program. Leesa played an integral role in the design, development, and implementation of Pennsylvania’s HealthChoices managed care program, including development of the Commonwealth’s managed care waiver and contractual language and program oversight and monitoring. In addition, Leesa was responsible for implementing value-based purchasing and quality incentives for providers and managed care organizations (MCOs) within the HealthChoices program. Leesa was also an active participant with the National Association of Medicaid Directors, selected by her peers to serve on the Board of Directors for the Eastern Region, and is a 2016 Fellow of the Medicaid Leadership Institute.

Current Responsibility

Leesa provides direct client consulting and leadership services including providing objective advice, expertise, and specialized skills in the area of healthcare policy, strategy and management with the aim of creating value, maximizing growth and/or improving the business performance of clients. In addition, Leesa leads Sellers Dorsey’s Research and Policy team, which conducts timely research and tracking of state and federal legislative, regulatory, and judicial actions impacting the Medicaid Program as well as the content and development of the weekly Sellers Dorsey Digest.

Education

  • Chatham College, BA, English
Brian Dees
As a former Senior Advisor to the Deputy Associate Commissioner for Medicaid and CHIP Policy and Program for Texas HHSC, Brian led high-profile Managed Long-Term Services and Supports (MLTSS) program implementations, interacted with a variety of stakeholders, developed Medicaid policy, and provided legislative analysis and ongoing management of provider and client-related issues to the Medicaid program in Texas. Prior to becoming a Senior Advisor, Brian worked as a Senior Policy Analyst conducting policy analysis related to acute care and LTSS in the Medicaid and CHIP programs.

Current Responsibility

Brian leverages his expertise in Medicaid managed care and health policy to provide technical, strategic, and business planning support to an array of Sellers Dorsey’s clients including state health plans, managed care organizations (MCOs), Medicaid support vendors, providers, and private equity firms. Brian also serves as a key member of the Sellers Dorsey Research and Policy team, which conducts timely research and tracking of federal legislative, regulatory, and judicial actions impacting Medicaid.

Education

          • University of Edinburgh, Th.M., Philosophy
          • Austin College, BA, Philosophy

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