CMS proposes changes to streamline Medicaid, CHIP managed care regulations


CMS proposes changes to streamline Medicaid, CHIP managed care regulations

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The Centers for Medicare & Medicaid Services (CMS) has proposed regulatory revisions to Medicaid and CHIP managed care to streamline and strengthen the program.

CMS said the changes reflect a broader strategy to relieve regulatory burdens; support state flexibility and local leadership; and promote transparency, flexibility, and innovation in care delivery.

“Today’s action fulfills one of my earliest commitments to reset and restore the federal-state relationship, while at the same time modernizing the program to deliver better outcomes for the people we serve,” said CMS Administrator Seema Verma.

According to CMS, the 2016 managed care regulations included provisions that many states and stakeholders identified as unnecessarily prescriptive and as adding unnecessary costs and administrative burden to state Medicaid programs without contributing to the improvement of health outcomes.

In addition, states expressed their concerns with how the 2016 final rule’s limitation of 15 days on lengths of stay for managed care beneficiaries in an institution for mental disease (IMD) created difficult administrative challenges for states.

CMS said it is not proposing any changes to this requirement at this time; however, it is asking for comment from states for data that could support revisions to this policy. Meanwhile, CMS continues to support state flexibility through section 1115 demonstrations, having approved a total of 15 waivers of the IMD exclusion for states to treat patients with substance use disorder (SUD), to expand access to treatment, and is exploring further options remove barriers to important treatment options.

As part of the efforts to reduce administrative burden, CMS formed a working group with the National Association of Medicaid Directors (NAMD) and state Medicaid Directors to create a framework to review and prioritize areas of concern within the managed care regulations.

Board president of NAMD, Judy Mohr Peterson, said: "Targeted improvements to the managed care rule have been a top priority for Medicaid Directors. NAMD appreciates the partnership shown by CMS to explore these issues and dialogue with the states, providing an opportunity to share perspectives on how the managed care regulatory framework could be improved. We look forward to reviewing CMS's proposed revisions and submitting formal comments."

CMS, Medicaid, Chip, Managed care, Seema Verma, US