Comments on the Centers for Medicare & Medicaid Services’ Proposed Medicaid Managed Care Rule

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July 2015

The Centers for Medicare & Medicaid Services (CMS) issued a Notice of Proposed Rulemaking for its first comprehensive update of Medicaid managed care regulations in over a decade on June 1, 2015. The proposed rule, CMS 2390-P, would modernize Medicaid managed care regulations to reflect the significant changes in Medicaid’s use of managed care during that period; align Medicaid managed care regulation with that of Medicare and commercial insurance; strengthen actuarial soundness; and promote delivery system reform.

In its July 2015 comments on the proposed managed care rule, MACPAC commends CMS on for doing “…a thoughtful job of balancing appropriate oversight expectations with opportunities for state and plan flexibility,” and calls on the agency to leverage resources so states can strengthen their administrative capacity and “effectively oversee their managed care programs in accordance with the new rules.” The Commission also points out that because states, not plans, administer Medicaid, and the program covers benefits that are not routinely offered by other payers, a Medicaid-specific approach to medical loss ratio may be appropriate in some cases in the final rule.

Publication Type: Comment Letters

Tags: administrative capacity, comparisons with other sources of coverage, consumer protections, data, managed care, risk adjustment