As part of the state-federal partnership in administering the Medicaid programs, the Centers for Medicaid and CHIP Services (CMCS) issues technical assistance in the form of letters to State Medicaid Directors, Informational Bulletins, Issue Briefs, and Frequently Asked Questions (FAQs) to communicate with states and other stakeholders regarding operational issues related to Medicaid. Managed care technical assistance is available to assist state Medicaid agencies in developing, enhancing, implementing, and evaluating managed care programs.
CMS published a Notice of Proposed Rulemaking titled “Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality (CMS-2439-P)”on April 27 2023. The proposed rule would strengthen standards for timely access to care and states’ monitoring and enforcement efforts; enhance quality as well as fiscal and program integrity standards for state directed payments (SDPs); specify the scope of in lieu of services and settings (ILOS) to better address health-related social needs (HRSNs); specify medical loss ratio (MLR) requirements; and establish a quality rating system (QRS) for Medicaid and CHIP managed care plans. Please submit any comments on this proposed rule by July 3, 2023. Additional Information:
- Fact Sheet: Ensuring Access to Medicaid Services (CMS 2442-P) and Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality (CMS-2439-P)
- Information on the related NPRM, also published on April 24, 2023 titled “Ensuring Access to Medicaid Services (CMS 2442-P)”
CMS has updated regulations for Medicaid and CHIP Managed Care in 2016, 2017, and 2020. Additional information on all updated Medicaid and CHIP Managed Care Final Rules is available. For questions regarding Managed Care, please email ManagedCareRule@cms.hhs.gov.
Medicaid and CHIP Managed Care Monitoring and Oversight
CMS is committed to strengthening the monitoring and oversight of Medicaid and CHIP managed care programs. To do so, the agency is developing a series of state reporting templates and technical assistance toolkits. Additional information on the Medicaid and CHIP Managed Care Monitoring and Oversight Tools is available. CMS looks forward to engaging and collaborating with states on the implementation of these tools and anticipates issuing additional tools periodically to improve its monitoring and oversight activities.
Guidance is also available on the following Topics: