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Modernizing Medicaid Managed Care

Efforts are underway to modernize managed care for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. On May 26, 2015, CMS issued proposed regulations that would update the programs’ rules for the first time in more than a decade. The proposal aims to strengthen the delivery of quality care for beneficiaries by improving beneficiary communications and access, fortifying accountability and program integrity tools, supporting state efforts to deliver higher quality care in a cost-effective way, and better aligning Medicaid and CHIP managed care rules and practices with other sources of health benefits coverage. Overall, the proposed rule would bolster federal and state efforts to provide quality, coordinated care to millions of Americans with Medicaid or CHIP coverage.

The proposed rule contains several provisions designed to strengthen states’ delivery system reform efforts and support local priorities and initiatives. Under the proposed rule, managed care plans could participate as critical partners in broad-ranging delivery system or performance improvement initiatives. Examples of such initiatives include patient-centered medical homes, efforts to reduce the number of low birth weight babies, broad-based provider health information exchanges and initiatives to improve health care access.

Find more information about the proposed rule here.

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