The Center for Medicare and Medicaid Services in June moved forward with a managed care rule which expands federal involvement in Medicaid programs. The move came despite vows from President Donald Trump’s administration to roll back regulatory independence to the states.
CMS announced the move will bolster the rate-setting process and increase transparency. According to the rule, managed-care contracts which began after July 1, 2017, must comply with the requirements, which implement stricter standards.
“Managed-care plans also must calculate and report their current medical loss ration, which is a breakdown of what the plans spend on medical care versus other activities, including employee salaries, marketing, profits and administrative tasks,” according to a Modern Healthcare report.
Managed-care plans must have a “medical loss ratio of at least 85%” by July 1, 2019, according to the report.
CMS also rejected a joint effort by several states to delay the rule’s implementation.
“These provisions in the final rule have significant federal fiscal implications for the Medicaid program and CMS will require compliance by the specified date in the final rule,” CMS Medicaid Director Brian Neale said in response to the states’ bid for delay.