On May 10, 2024, the Centers for Medicare & Medicaid Services (CMS) published the Medicaid and Children’s Health Insurance Program (CHIP) Managed Care final rule in the Federal Register.
The final rule aims to create new standards to “improve access to care, quality and health outcomes, and better address health equity issues” for Medicaid and CHIP managed care enrollees. The rule details that the volume of Medicaid beneficiaries enrolled in a managed care program in Medicaid has grown from 81% in 2016 to 85% in 2021, with 74.6% of Medicaid beneficiaries enrolled in comprehensive managed care organizations in 2021.
More specifically, the rule establishes new standards for appointment wait times, use of secret shopper surveys, and use of enrollee experience surveys. It requires states to submit a managed care plan analysis of payments made by plans to providers for specific services to monitor plans’ network adequacy more closely.
The final rule officially takes effect on July 9, 2024, however additional applicability dates range from sixty days to six years following the effective date.