CMS Proposes Update to Medicaid Managed Care Regulations.

Date posted: July 2, 2015

The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule updating Medicaid managed care regulations to align with changes in the usage of managed care delivery systems.

Key highlights of the proposed rule include:

  • Alignment of Medicaid managed care regulations with major sources of coverage including Qualified Health Plans and Medicare Advantage plans;
  • Strengthening of actuarial soundness payment provisions to promote accountability of payment rates and overall programmatic integrity;
  • Promotion of a quality of care framework requiring a quality strategy and quality rating system for each state’s Medicaid program;
  • Strengthening state delivery system reform by striving to control costs while also improving beneficiary outcomes and experience; and
  • Alignment of the Children’s Health Insurance Program managed care regulations with proposed Medicaid managed care rule revisions.

CMS is accepting comments on the proposed rule until July 27, 2015.

The proposed rule is available at:

The CMS fact sheet is available at:

Medicaid and Children’s Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, Medicaid and CHIP Comprehensive Quality Strategies, and Revisions Related to Third Party Liability; Proposed Rule; 80 Fed. Reg. 31097 (June 1, 2015).

The Centers for Medicare & Medicaid Services.  “Medicaid and CHIP Managed Care Proposed Rule CMS-2390-P.”  Fact Sheet.  26 May. 2015.

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