HHS providing resources to states for oversight of Medicaid, CHIP managed care

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The Department of Health and Human Services, through the Centers for Medicare and Medicaid Services, has released a suite of resources meant to improve CMS and state oversight of Medicaid and Children's Health Insurance Program managed care programs – which 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), the new information includes tools, templates and updates on tactics geared to improve states' reporting on their managed care programs.

HHS Secretary Xavier Becerra said the agency is working with states on implementation, and framed the move as a means of strengthening the oversight and transparency of Medicaid and CHIP managed care programs.

Among other things, the 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.

The CIB also includes information about timely and accurate payment to Indian Health Care Providers, many of whom participate in managed care. To assist states in complying with specific protections for these 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.

WHAT'S THE IMPACT?

The managed care reporting templates are expected to 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 – to CMS, as well as network adequacy, a measure of how well a plan delivers its actual benefits.

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 is complete. CMS will be creating a webpage on Medicaid.gov, where states will be able to review the reports, which are currently available on request.

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, said HHS.

THE LARGER TREND

The CIB builds on a June 2021 informational bulletin that 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.

Over the last 10 years, the majority of people with Medicaid and CHIP coverage were enrolled in managed care, underscoring the need for strong federal and state oversight, HHS said.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com