CMS releases long-awaited rules for Medicaid managed-care plans

The CMS has released a sweeping draft rule intended to modernize the regulation of Medicaid managed-care plans (Source: “ ‘Milestone’ Rules Would Limit Profits, Score Quality For Private Medicaid Plans,” Kaiser Health News, May 26, 2015). 

The rule would create profit guidelines for private Medicaid plans as well as new standards for the plans’ doctor and hospital networks and rules to coordinate Medicaid insurance more closely with other coverage.

In Ohio, about 90 percent of Medicaid enrollees are covered by managed-care plans.

The 653-page rule, which also would require states to establish quality ratings for Medicaid plans, constitutes the biggest regulation change to Medicaid managed care in more than a decade. The National Association of Medicaid Directors, a group of state officials, called it a “milestone.” The rules published in late May are only proposals. HHS will take comments until late July and issue final rules later.