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Final rule on managed care in medicaid & children's health insurance program announced


On Monday, April 25, 2016, HHS released its final rule on managed care in Medicaid & the Children's Health Insurance Program (CHIP). The rule is the first overhaul of managed care regulations for the two programs in more than a decade and caps the medical-loss ratio at 85%.


The rule, which will be implemented in phases over the next three years, beginning July 1, 2017, has four main goals:


  1. Supporting states' efforts to advance delivery system reform and improvements in quality of care for Medicaid & CHIP beneficiaries;
  2. Strengthening the consumer experience of care;
  3. Strengthening program integrity via accountability and transparency; and
  4. Aligning rules across health insurance coverage programs.

This rule was scheduled to be published in the Federal Register on May 6th. For further reading on this topic, please see the CMS blog, in which CMS Acting Director Andy Slavitz and CMS Deputy Administrator Vikki Wachino outline major developments in Medicaid and the background for the new rule. OPSC will continue to monitor this issue on behalf of all DOs.

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