• Analysis or Summary
  • January 15, 2019

Medicaid Managed Care Proposed Rule

On Nov. 14, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that makes changes to the 2016 Medicaid managed care final rule. CMS notes that it made these changes to respond to feedback from stakeholders and specifically referred to a workgroup of state Medicaid directors. Although many expected a larger overhaul of the rule, this proposed rule makes smaller scale changes to give states a bit more flexibility in the areas of rate setting, pass through payments, information requirements and network adequacy. Some of the proposed changes apply only to managed care under Medicaid, while others also apply to managed care under the Children's Health Insurance Program (CHIP). The summary by CHA highlights those changes most likely to be of interest to children's hospitals. 

Additionally, CHA submitted a comment letter on the Medicaid managed care rule. The comment letter focuses on changes proposed in the rule related to network adequacy, directed and supplemental payments and quality ratings systems. We will also provide our 2015 comment letter to CMS to share additional areas we would like to see strengthened more broadly for children.