New CMS Medicaid managed care rule introduced

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An ambitious and comprehensive policy-making effort that promises to completely transform and radically overhaul the Medicaid managed care marketplace has passed White House Office of Management and Budget (OMB) review. That's paving the way for the Centers for Medicare & Medicaid Services to issue a final rule soon, according to published reports.

More than 42 million Americans are currently enrolled in some form of Medicaid managed care, according to a Henry J. Kaiser Family Foundation report. That number represents more than 42% of state Medicaid enrollment. Nursing home leaders call it “risky business.”

The plan, first announced in the fall of 2014, would align Medicaid Managed Care regulations with existing commercial, Marketplace, and Medicare Advantage regulations. It's been more than 13 years since the regulations have been updated.

Provider groups have already welcomed the updates but in general have asked CMS to tread lightly. Louisiana's nursing homes are defiantly resisting efforts there to participate in the state's nascent Medicaid managed care program.

An American Health Care Association report calls the growth of managed care in dealing with older adults a "risky business.” The association asserts that states have limited experience in managed long-term services and supports.