Key Actions for States on CMS Access and Managed Care Rules

The Centers for Medicare & Medicaid Services (CMS) has issued final rules on access and managed care, introducing significant changes that will impact states in regard to payment, operations, oversight, reporting, compliance, and staffing.

The final rules ultimately change the way state Medicaid agencies conduct business across a large swath of Medicaid programs—presenting new challenges and complexities for states. However, CMS has defined deadlines over the next six years and outlines several exceptions or flexibilities available to states.

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In this white paper, Guidehouse provides in-depth guidance on key actions for states on:

Ensuring Access to Medicaid Services Final Rule (CMS-2442-F)

This rule builds on continuous efforts to improve healthcare access and quality. It emphasizes enhancing home and community-based services and increasing transparency and public accountability. It also requires more comprehensive data reporting and monitoring for the Medicaid fee-for-service and managed care delivery systems.

Medicaid and Children’s Health Insurance Program Managed Care Access, Finance, and Quality Final Rule (CMS-2439-F)

With this rule, CMS introduces updates aimed at improving care access, quality, and outcomes in six primary areas:

• Access to care
• State-directed payments
• Medical loss ratio
• In lieu of services
• Quality strategy and external quality review
• Quality ratings system

Guidehouse is available to help states navigate these actions and related complexities.

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