Medicaid and the Law: CMS Releases the New Medicaid Managed Care Final Rule

“On November 9, 2020, the Centers for Medicare and Medicaid Services (“CMS”) announced it finalized the Medicaid and Children’s Health Insurance Program (“CHIP”) Managed Care final rule (“2020 final rule”). According to CMS, the 2020 final rule advances CMS’s efforts to streamline the Medicaid and CHIP managed care regulatory framework and ‘reflects a broader strategy to relieve regulatory burdens; support state flexibility and local leadership; and promote transparency, flexibility, and innovation in the delivery of care.’”

“Notably, in 2016 the Obama Administration promulgated a Medicaid Managed Care final rule of its own (“2016 final rule”). The 2016 final rule, the first Medicaid managed care regulation since 2002, primarily sought to establish state and managed care plan requirements and strengthen Medicaid beneficiary protections in a variety of different ways.”

“However, according to CMS, the 2016 rule drew criticism from state Medicaid directors and managed care organizations (“MCOs”) because the rule imposed excessive administrative burdens. The Trump Administration subsequently proposed and finalized the 2020 final rule, which is primarily a revision of the 2016 final rule and not a replacement, to account for changes in “the landscape for healthcare delivery” and the recent experience of states. In practice, the 2020 final rule can be seen primarily as an effort to relax state requirements and beneficiary protections established in the 2016 final rule.”

“The 2020 final rule makes the following key changes…” Read the full article here.

Source: CMS Releases the New Medicaid Managed Care Final Rule – By Thomas Barker et. al., November 13, 2020. Medicaid and the Law.

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