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May 05, 2023

CMS Proposes Rules to Improve Access to Medicaid and CHIP Programs

CMS recently announced proposed rulemaking to improve care provided to Medicaid and CHIP beneficiaries.  On May 3, 2023, CMS published a proposed rule that would apply to Medicaid and CHIP managed care plans with the goal of improving access to care and outcomes, and of improving health equity.  Specific areas covered by the proposed rule include timely access to care, monitoring and enforcement by states, the process for state directed payments and quality reporting, new standards for when states use “in lieu of services and settings (ILOSs),” medical loss ratios, and a quality rating system the managed care plans.

CMS concurrently published a second proposed rule applying to the Medicaid fee-for-service program, in-home and community-based programs, and managed care systems.  would require states to (i) make all FFS Medicaid payment rates public and accessible on a state website and (ii) report on their state Medicaid rates relative to comparable Medicare FFS rates, establish an advisory group for current or proposed payment rates, and alter the current requirements for states submitting access monitoring review plans.  Comments on both proposed rules are due by July 3, 2023.

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