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CMS Releases Final Medicaid Managed Care Rule

Wednesday, May 11, 2016

Recently, the Centers for Medicare and Medicaid Services (CMS) published a final rule overhauling federal regulations governing Medicaid managed care programs. The comprehensive regulation addresses all aspects of managed care. Key elements of the final rule include:

  • The removal of a proposed 14-day period of fee-for-service coverage while a beneficiary selects a plan
  • The phase-out of supplemental payments to hospitals over the next 10 years and supplemental payments to physicians and nursing facilities over the next 5 years
  • Allowing rate ranges of above or below 1.5% of a target rate without requiring additional federal rate review
  • Finalizing the proposed coverage of a monthly limit of 15 days in an Institution for Mental Disease (IMD).

READ the rule and additional supporting materials.