Long-awaited CMS proposed re-regulation of Medicaid managed care is now up on Federal Register: s3.amazonaws.com/public-inspect… Two significant areas of concern on first read.
2. First, the proposed rule turns what were already limited federal standards for how states measure the adequacy of plan networks into a completely open-ended requirement to essentially just file some description of a standard.
3. The previous rule required states to have some “time and distance” measure of access to physicians and other providers, and also to have specialist-specific federal review. Specialists are a long standing issue for Medicaid but some states have excellent specialist standards.
4. Both of these are removed in the proposed rule. These were the only specific requirements of states regarding network adequacy in the previous rule so this is a significant weakening of what was already a highly flexible federal oversight framework.
5. Network is really important to consumers, and this rule would leave CMS oversight of managed care networks as at best incredibly vague and more likely a legal fiction.
6. Second, there is a significant proposed expansion of the state option to develop its own alternative to the national Medicaid Quality Rating System. CMS is trying to thread a needle but the result is a much smaller set of measures by which to evaluate plan and state quality.
7. The proposal changes “an alternative state QRS produce substantially comparable information to that yielded by the CMS-developed QRS” to “the information yielded be substantially comparable to the extent feasible to enable meaningful comparison across states”.
8. The proposal then--trying to salvage a national Medicaid quality rating framework--adds “a uniform set of mandatory measures”. Well, the original rule envisioned a uniform set of mandatory measures, and it was called a national quality rating system.
9. This will lead to a CMS quality rating that is a lot less than national & a set of mandatory measures that tells CMS or consumers much less than what they should know. CMS leadership’s emphasis on state accountability and emphasis on state flexibility are in conflict on this.
