Modernizing Medicaid Managed Care: Navigating CMS' Long-Awaited and Overhauled Proposed Regulations

Description

On June 1, the Centers for Medicare & Medicaid Services (CMS) issued long-awaited proposed regulations to modernize Medicaid managed care. Since CMS’ last overhaul in 2002, Medicaid managed care has exploded to reach over 39 million people – or 58% of all Medicaid beneficiaries – based on 2011 data. Currently, 39 states use managed care organizations to administer their Medicaid benefits.

The proposed regulations updates the Medicaid managed care regulations to reflect changes in the usage of managed care delivery systems and to align the rules governing Medicaid managed care with those of other major sources of coverage, including commercial markets, Exchange-based Qualified Health Plans and the Medicare Advantage and Part D Programs. Among the most significant proposed changes are new standards for network adequacy and medical loss ratios (MLRs) as well as a revised framework for setting capitation rates.

Healthcare stakeholders have until July 27, 2015, to provide comments on the proposed regulations. With proposed changes that touch everything from network adequacy to quality improvement initiatives, it is critical for healthcare counsel to understand the impact the proposed regulations will have and be prepared to respond.

Listen as our authoritative panel examines the proposed regulations, analyzes who will be impacted—and how, and addresses the likelihood of the rule being adopted and expected challenges. The panel will also address what counsel needs to do now regarding compliance that could be impacted if/when the rule is adopted.