CMS plan would completely overhaul Medicaid managed care

Over the next few weeks, the Centers for Medicare & Medicaid Services is expected to unveil an ambitious and comprehensive policy-making effort that promises to completely transform and radically overhaul the Medicaid managed care marketplace.

Few specifics are known about the plan, but observers say it could align Medicaid managed care regulations “with existing commercial, marketplace, and Medicare Advantage regulations,” as well as provide guidance to states on rate setting, Bloomberg News services reported.

It's been 13 years since CMS last addressed Medicaid managed care policy, and the new plan likely will account for consumers' thirst for comparative information on the Internet. Lobbyists told the news service they were hopeful of a regulation that would modernize Medicare managed care policy in as unrestricted way as possible.

The Department of Health & Human Services reports that more than half of all Medicaid beneficiaries receive all or some of their care from risk-based managed care organizations, which in most states assume all of the risk for delivering all primary, specialty and acute medical care in exchange for a fixed monthly fee.

Currently, Medicaid beneficiaries are enrolled in comprehensive managed care plans in 38 states and the District of Columbia and many states are turning to managed care programs to handle the huge increase in Medicaid beneficiary rolls, the news service added.

Whatever is in the new CMS plan, it's likely going to take some overhaul at the agency itself. A GAO report earlier this year claimed that CMS and states “lack effective program integrity systems for care delivered by managed care organizations.”

In a related development, a new Medicare accountable care organization is reportedly being modeled closely after a controversial managed care program that includes new waivers for skilled nursing facilities.