Medicaid Managed Care Final Rule

The Centers for Medicare & Medicaid Services (CMS) issued the final Medicaid “mega-rule,” a huge regulation that makes changes to every part of the current managed care rules. Although the final rule makes some tweaks based on the comments received from the industry, it largely adopts the proposals released last May. The new changes will be phased in over the course of three years, with some provisions going into effect starting July 1, 2017.

The new regulation, in essence, brings Medicaid managed care into the 21st century. Many of the new changes align the Medicaid program with Medicare Advantage (MA) and Exchange regulations currently in place. The rule encourages efficient, realistic use of limited resources, creating more incentives to improve clinical outcomes, reduce cost, and improve benefit coverage.
(From linked document: Medicaid Final Rule Aligns the Program with MA and Exchange Regulations)

Links and Presentations:


MLTSS Association Activities Regarding Medicaid Managed Care Final Rule