The CMS proposal yesterday to overhaul the oversight and regulation of Medicaid managed care plans comes at a time when the adoption of innovative care and reimbursement techniques and enrollment in state Medicaid managed care programs is greater than ever.

Among the states leading the way in innovation are Oregon, Vermont and New York, as described by H&HN in January. Driven by financial necessity, state Medicaid reforms generally are being more quickly adopted than federal pilot projects. In the innovating states, one can find widespread use of such things as patient-centered medical homes and bundled payments.


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And relative enrollment, including the more traditional versions of managed care, has increased greatly. In 1992, only 8 percent of Medicaid beneficiaries accessed at least some of their benefits via capitated health plans. In 2011, the participation rate was 58 percent, according to a CMS fact sheet. Yet, the last time CMS revised Medicaid managed care oversight was in 2002 and 2003.

The changes announced yesterday are intended to assist beneficiaries who move in and out of Medicaid managed care plans as their coverage changes, Acting CMS Administrator Andy Slavitt said during a press call.

So, aligning Medicaid managed care with the rest of the industry also is a goal. "This proposal takes significant strides in bringing the best practices found in other plan areas, such as Medicare Advantage and the private market, in the delivery of high-quality health care services to beneficiaries," Slavitt said.

He added that the three major changes relate to boosting transparency and consumer engagement, improving and managing care coordination, and enabling delivery system reform.

The CMS proposal seeks a number of major changes, according to a fact sheet, including:

• Give states more flexibility in implementing Medicaid delivery reform.

• Mandate that states adopt a quality strategy.

• Implement a quality rating system that would include all of the state's Medicaid health plans and align with what's used in Medicare Advantage and in ACA-created marketplaces.

The proposed rule would apply in a similar fashion to the Children's Health Insurance Program.