CMS Issues Proposed Rule Addressing Managed Care Regulations

This week, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule updating the way states should implement managed care programs within the Medicaid program, including those covering long term care services and supports (LTSS).  As this rule was just released, VHCA staff is still reviewing the proposed changes in terms of their relevance under the Commonwealth Coordinated Care (CCC) program and any future iteration of managed LTSS (MLTSS) in Virginia.  Two weeks ago in this publication, we discussed the plans announced by the Department of Medical Assistance Services (DMAS) regarding changes to CCC and a future statewide Medicaid MLTSS program, including nursing facility services (see the CCC update from May 14).  As the discussions around these future plans evolve, the rule issued by CMS will certainly need to be considered in that design.

While we are still very much reviewing the proposed rule’s 654 pages, we have seen that the rule addresses:

  • time and distance standards specifically for MLTSS programs
  • provisions to improve the beneficiary’s experience in enrollment, communications from the state and managed care plans, care coordination, and the availability and accessibility of covered services
  • a quality framework focused on transparency, alignment with other systems of care, and consumer and stakeholder engagement
  • better alignment with Medicare Advantage and private coverage plans

As we learn more about the proposed rule, specifically how it relates to the CCC program and future plans for a Virginia MLTSS statewide program, we will provide additional updates.  A copy of the proposed rule can be downloaded here.