On May 6, 2016 the Centers for Medicare & Medicaid Services released a final rule modernizing Medicaid managed care regulations. The rule contains provisions to strengthen actuarial soundness, protect beneficiaries, enforce program integrity, and promote quality of care. The rule also addresses changes in the patient mix that have occurred since previous rule was issued, as well as significant growth in managed long-term services and supports, which has unique delivery and payment mechanisms.
This presentation provides background on managed care regulation and an overview of the significant provisions in the final rule. It concludes with an outline of MACPAC’s next steps in this area, which include additional analyses of managed care enrollment and spending trends and managed care program integrity, an area of longstanding interest to the Commission but difficult to analyze in the absence of a final regulation.