CMS Proposes Major Changes to Medicaid and Children’s Health Insurance Program Regs

This week, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule to better align the regulations governing Medicaid and the Children’s Health Insurance Program to make them more consistent with the federal rule governing commercial, marketplace, and Medicare Advantage plans. The proposed rule would “modernize Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations to update the programs’ rules and strengthen the delivery of quality care for beneficiaries,” according to a May 26 press release from CMS. As the press release noted, “This proposed rule is the first major to Medicaid and CHIP managed care regulations in more than a decade. It would improve beneficiary communications and access, provide new program integrity tools, support state efforts to deliver higher quality care in a cost-effective way, and better align Medicaid and CHIP managed care rules and practices with other sources of health insurance coverage.”

There are numerous elements to the proposed rule, several of which have healthcare data and IT implications, including these:  “supporting states’ efforts to encourage delivery system reform initiatives within managed care programs that aim to improve healthcare outcomes and beneficiary experience while controlling costs; and strengthening the quality of care provided to beneficiaries by strengthening transparency and measurement, establishing a quality rating system, and broadening state quality strategies and consumer and stakeholder engagement”; and “improving consumer experience in the areas of enrollment, communications, care coordination, and the availability and accessibility of covered services.”

The proposed rule is available here.