Information is accurate as of September 27, 2023
In April 2023, CMS proposed changes to both the Medicaid Managed Care regulations as well as the Medicaid Access to Care rule. The Medicaid Managed Care rules are designed to enhance accountability, transparency, and beneficiary involvement in the Medicaid program. The Access to Care rule is related to enrollee experience with care for both Fee for Service (FFS) and managed care enrollees. This rule is focused on payment adequacy, rate and access transparency, and the quality of Medicaid’s home and community-based services (HCBS).
Among the proposals are rules regarding:
- Provider Network Adequacy – requiring states to develop wait-time standards for appointments, use an independent entity to conduct secret shopper surveys, among other mandates
- State-Conducted Annual Enrollee Experience Survey
- Medical Loss Ratio
- EQR Annual Technical Report (ATR) Changes including new submission date of 12/31
- Medicaid Managed Care (MMC) Quality Rating System (QRS) – requiring states to collect from MCOs the data necessary to calculate ratings and ensure that all data are validated
Once the rules are finalized, IPRO will schedule a 30-minute webinar to share insights and strategies for ensuring compliance. Click here to join our email list to be notified as soon as final rules are released and registration for IPRO’s webinar opens.