ACAP Reaction to updated federal Medicaid managed care regulations

In late April, the Centers for Medicare & Medicaid Services (CMS) released the most significant overhaul to the regulations governing Medicaid managed care since 2003. The release of the final regulations caps a nearly year-long review process of overhauling these regulations; the draft (or proposed) regulations were released in June of last year.  And despite coming in at more than 1,400 pages, these regulations have had comparatively few changes since the Notice of Proposed Rulemaking was issued last summer.

Given the scope and sheer length of the regulations, we took a little time to review the regulations and compare them with our notes from last summer before providing a detailed response. 

ACAP was generally pleased with some of the changes brought about by this update, although significant room for improvement remains. Highlights of our response to the new regulations follow.

Network adequacy: While network adequacy was largely left to the states, ACAP applauded CMS's recommendation to account for telemedicine in determining network adequacy. Many Safety Net Health Plans have seen some real success in improving access to care through telemedicine, whether it’s reducing wait times for patients to get in t o see specialists, or in some cases where there are real shortages, to see specialists at all.

Proposed 14-day period of fee-for-service coverage for new enrollees: CMS proposed to requiring new enrollees in voluntary managed-care programs to first spend 14 days in a fee-for-service environment. This would have simply baked in confusion, fragmentation of care, disrupted access, and complications around provider reimbursement as part of the intake process. ACAP urged CMS to decline this proposal, and CMS was right to concur.      

Provider directories: ACAP applauded CMS harmonizing the requirements around electronic provider directory updates with rules governing Medicare and Marketplace coverage.
 
Quality measurement and reporting: A proposed provision of the regulation had been that states develop a quality strategy plan which includes Medicaid fee-for-service arrangements. That language was not included in the final regulation, and it’s a missed opportunity. Comprehensive quality data shouldn’t be limited to people in managed care plans. Similarly, CMS should have modified the proposed Quality Rating System so it applies to all delivery systems, including fee-for-service and emerging delivery systems. 

On IMD services (IMD) as an “in-lieu-of” service: CMS opted to allow states to provide capitations payments to plans for services received at an IMD for psychiatric or substance use disorder treatment. However, it’s bounded by a 15 day-per-month limit, which may be insufficient for certain courses of treatment. ACAP is also concerned with certain provisions related to rate-setting for these services.

Our response in full is available on ACAP's Web site. I encourage you to take a look - and share your thoughts. 

Meg Murray
CEO

Association for Community Affiliated Plans
202.204.7509    
www.communityplans.net   |   @safetynetplans