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April 26, 2024

CMS Issues Final Medicaid Managed Care Rule

On April 22, 2024, CMS issued its much-anticipated Final Rule regarding several aspects of Medicaid Managed Care. The Final Rule includes significant regulatory changes for key areas of Medicaid Managed Care practice, such as standards for timely access to care and states’ monitoring and enforcement efforts, program integrity standards for state directed payments (SDPs), in lieu of services and settings (ILOSs) and health-related social needs (HRSNs), and medical loss ratio (MLR) requirements. The Final Rule also establishes a quality rating system (QRS) for Medicaid and CHIP managed care plans. The CMS fact sheet is available here, the full unpublished rule here

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