Contemporary Pediatrics

By: Kathryn Foxhall

The Centers for Medicare and Medicaid Services, known as CMS, released the rules for improving Medicaid managed care, which set new orders for the states to created rules for managed care plans helping Medicaid beneficiaries, because in 2013, about 39 states were utilizing it in their Medicaid programs.

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“The rule is going to require more consumer information than we have ever had before,” says Kelly Whitener, associate professor at the Georgetown University Health Policy Institute Center for Children and Families, Washington, DC. That will be very important in helping consumers to understand their plans, she notes.

The rules will require that managed care plans are constantly updating the provider directories, to ensure frequent supervising. These will also allow both states and managed care plans to use various electronic communication methods, as long as the beneficiaries also receive that information free of cost.

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Also, the rules will allow for states to assign their beneficiaries to plans based on a process that, at the same time, gives a period of time for the enrollee to select a plan or choice of delivery system. In addition, the rules indicate that the majority of the funds must be spent on claims and quality improvement issues instead of administrative expenses. Also, plans must provide enough family planning network.

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Whitener of Georgetown points out that for the first time the rules require that the managed care contracts be posted on the state website. That will be “really important” in helping research and advocacy groups understand what is happening, she says. Currently, the documents must be obtained through a Freedom of Information Act request, she says.

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