Medicaid managed care overhaul rule goes to OMB for review

The White House Office of Management and Budget is expected to issue the final rule in May
The White House Office of Management and Budget is expected to issue the final rule in May

A rule that aims to drastically overhaul Medicaid's managed care regulations was sent to the Office of Management and Budget for review last week.

The rule, first announced in May 2015, will “modernize” Medicaid managed care regulations for the first time since 2002. The updated regulations will reflect changes in the way managed care is delivered to beneficiaries, and correct inconsistencies that have developed as states have implemented their own managed care programs, according to the Department of Health and Human Services.

The 635-page proposed rule, which was sent to the OMB last Thursday, includes provisions that would require states to establish quality strategies for Medicaid programs and better assess the adequacy of plan's provider networks.

The rule also includes proposals for expanding managed long-term services and supports, among them increasing stakeholder engagement and developing quality measures specific to managed LTSS.

“The current Medicaid managed care regulations were written at a time when a managed

care delivery system was not frequently utilized for LTSS,” the rule reads. “With states using managed care to deliver covered services to populations with more complex needs, care coordination that is appropriate for individuals using LTSS becomes an important component of managed care.”

The rule would cost an estimated $112 million to implement, HHS said. OMB reviews can take as long as 90 days, so the final rule is expected to be published in May.

Close to 46 million people, or 73% of all Medicaid beneficiaries, have a managed care plan, and that number is expected to increase as the Affordable Care Act expands Medicaid coverage to low-income adults, Modern Healthcare reported.

Click here to read the full Medicaid managed care proposal.