The federal government issued a major overhaul to a key Medicaid program that could affect how nearly 50 million low-income Americans get healthcare coverage.
The Centers for Medicare and Medicaid Services released a final rule Monday that updates the Medicaid and Children’s Health Insurance Program’s managed care program, which refers to a delivery system meant to lower cost and improve quality of care.
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The regulations, the first update in 13 years, aim to help Medicaid beneficiaries by improving insurance plan standards in terms of quality and types of providers offered.
It also improves state and managed care plan standards for enrollment, communications with patients and coordination of the care provided, HHS said.
It also aims to help out states, which play a key part in Medicaid managed care programs.
Under a managed care system, a state Medicaid program and insurer agrees on a per-month payment for healthcare services and how many members can be included in the system, according to CMS.
Currently 39 states and the District of Columbia use the system, affecting about two-thirds of the 72 million Medicaid beneficiaries, according to the Department of Health and Human Services.
The intention of the final rule is to help states to find a managed care plan and work with insurers. It includes a quality rating system that would show the performance information on all health plans.
The rule also establishes network adequacy standards for Medicaid and CHIP managed care for “key types of providers, while leaving states flexibility to set the actual standards,” HHS said.
The agency noted that the provisions of the rule would be phased in over the next three years starting in July.
The push to improve quality of care comes as part of a larger effort tied to Obamacare that seeks to reimburse doctors under Medicare based on the care they provide, rather than the current fee-for-service system.
