CHA News Article

CMS Proposes Changes to Medicaid Managed Care and CHIP
Comments due Jan. 14

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that revises Medicaid Managed Care and Children’s Health Insurance Program (CHIP) regulations.

CMS states that the proposals are intended to reduce state administrative burden and increase program flexibility. The proposed rule significantly revises regulations on setting actuarially sound capitation rates, pass-through payments, state directed payments, network adequacy standards, quality rating systems, appeals and grievances, and requirements for beneficiary information.

CMS notes that states have expressed concerns with the current limitation of 15 days on lengths of stay for managed care beneficiaries in an institution for mental disease. While CMS does not propose any changes to this requirement, it seeks data that could support a future policy change.

CHA is reviewing the proposed rule and is particularly focused on understanding the proposed changes related to pass-through and directed payments, and what implications or opportunities there may be as it relates to the Hospital Fee Program supplemental managed care payments. CHA will provide additional detail in the coming weeks.

More information is available in a CMS fact sheet. Comments on the proposed rule are due Jan. 14.

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