On June 1, 2015, the Centers for Medicare and Medicaid Services (“CMS”) published proposed regulations that will impose comprehensive changes on the Medicaid managed care system, including its behavioral health providers and payers.
The proposed regulations include measures to address the following areas of special interest to the behavioral health community: (a) align Medicaid managed care plan standards with those applicable to commercial markets, Medicare Advantage plans and Exchanged-based Qualified Health Plans; (b) impose new Medical Loss Ratio (MLR) standards; (c) require compliance with new provider network adequacy standards, (d) impose new quality of care measurement standards and a quality rating system; (e) make changes to the actuarial soundness provisions; and (f) improve beneficiary protections.
When final, these rules will have a sweeping impact on the behavioral health community of providers and payers, alike. CMS is accepting comments on the proposed rules, which may be submitted by mail or electronically, through July 27, 2015. The submission of thoughtful, relevant comments is one way in which the behavioral health community can inform CMS about potentially troubling aspects of the proposed rules, ultimately helping to shape the rules’ final form.