CMCS Issues Two Final Rules: Ensuring Access to Medicaid Services and Medicaid and CHIP Managed Care Access, Finance, and Quality
Today, the CMS Center for Medicaid and CHIP Services (CMCS) issued two final rules: Ensuring Access to Medicaid Services (Access Rule) and Medicaid and Children’s Health Insurance Program Managed Care Access, Finance, and Quality (Managed Care Rule). Together, the rules advance access to care and quality of care and improve health outcomes across fee-for-service (FFS) and managed care plans.
The Access Rule addresses critical dimensions of access across both Medicaid FFS and managed care delivery systems, including for home and community-based services (HCBS). These improvements seek to increase transparency and accountability, standardize data and monitoring, and create opportunities for states to promote active beneficiary engagement in their Medicaid programs, with the goal of improving holistic access to care. Read the full final rule on the Federal Register and the fact sheet and applicability dates table on Medicaid.gov.
The Managed Care Rule strengthens standards for timely access to care and states’ monitoring and enforcement efforts; enhances quality and fiscal and program integrity standards for state directed payments (SDPs); specifies the scope of in lieu of services and settings (ILOSs) to better address health-related social needs (HRSNs); further specifies medical loss ratio (MLR) requirements; and establishes a quality rating system (QRS) for Medicaid and CHIP managed care plans. Read the full final rule on the Federal Register and the fact sheet and applicability dates table on Medicaid.gov.
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