|
Today,
the U.S. Department of Health and Human Services (HHS), through the Centers
for Medicare & Medicaid Services (CMS) unveiled a suite of new
resources to improve CMS and state oversight of Medicaid and Children’s
Health Insurance Program (CHIP) managed care programs. These programs
provide people with health benefits and additional services through
contracted arrangements with managed care plans. Released in a Center
for Medicaid and CHIP Services Informational Bulletin (CIB), this
new information includes tools, templates, and updates on tactics to improve
states reporting on their managed care programs, which promotes access to
care for millions of people enrolled in Medicaid and CHIP.
“Today
we are taking action to strengthen the oversight and transparency of
Medicaid and CHIP-managed care programs,” said HHS Secretary Xavier
Becerra. “We are working hand-in-hand with states and doubling down on our
efforts to improve access to health care for the millions of Americans
enrolled in these programs.”
“Ensuring
access to health care for people enrolled in Medicaid and CHIP is a
critical priority for the Biden-Harris Administration,” said CMS
Administrator Chiquita Brooks-LaSure. “The tools we’re releasing today
reflect the latest—and certainly not the last—step CMS is taking to
increase transparency and ensure that people served through Medicaid and
CHIP managed care programs are receiving high-quality, high-value care.”
Among
other highlights, today’s CIB outlines the latest updates to a new
web-based portal for state reporting on managed care programs to CMS. It
also offers additional reporting templates and a new technical assistance
toolkit, to help states improve their overall monitoring and oversight of
managed care.
Recognizing
the unique needs of Indian Health Care Providers, many of whom participate
in managed care, the CIB also offers information about ensuring timely and
accurate payment to such providers. To assist states in complying with
specific protections for American Indian and Alaska Native communities, the
CIB recommends specific practices and strategies to aid states and managed
care plans in implementing statutory and regulatory Medicaid managed care
protections for Alaska Natives and American Indians.
The
managed care reporting templates released today will provide a standard
format for states to report managed care medical loss ratios (a measure
that helps encourage health plans to provide value to enrollees) and
network adequacy (a measure of how well a plan delivers its actual
benefits) to CMS. To promote transparency in Medicaid and CHIP, the CIB
also reminds states of the requirement to post their Network Adequacy and
Access Assurances reports on a state website for each program they operate.
CMS will make all reports submitted through Managed Care Reporting
available after an initial review of reports are complete. CMS will be
creating a webpage on Medicaid.gov where states will be able to review the
reports. Reports are currently available upon request.
As
an additional step to aid states and the individuals many Medicaid and CHIP
programs serve, CMS also released a toolkit to support program monitoring
for Medicaid enrollees in Managed Long-Term Services and Supports (MLTSS)
—specific managed care programs that can help ensure more people with
long-term care needs transition from institutions to home and
community-based settings. The toolkit, “Promoting Access in Medicaid and
CHIP Managed Care: Managed Long-Term Services and Supports Access
Monitoring Toolkit,” was developed in response to MLTSS growth and federal
oversight concerns about access to services and quality-of-care.
Today’s
CIB builds on a June 2021 informational bulletin, which provided a
reporting template for the Annual Managed Care Program Report, announced
the development of the web-based reporting portal, and released two
technical assistance toolkits related to quality and behavioral health
network adequacy for state use.
Improvements
in health plan performance, care quality, and outcomes are key objectives
of Medicaid and CHIP managed care programs. Over the last ten years, the
majority of people with Medicaid and CHIP coverage were enrolled in managed
care. Its increased use underscores the need for strong federal and state
oversight, which is why resources like today’s CIB are key.
To
view the Medicaid and CHIP Managed Care Monitoring and Oversight Tools CIB,
please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/cib07062022.pdf.
|
No comments:
Post a Comment