CMS Unveils Tools to Improve State and Federal Oversight of Medicaid Managed Care Plans

The Centers for Medicare and Medicaid Services (CMS) released and updated several tools last week to improve oversight and transparency of Medicaid managed care plans, including Managed Long Term Care (MLTC) plans. The new tools, outlined in a Center for Medicaid and Children’s Health Insurance Program (CHIP) Services Informational Bulletin (CIB), include an update on the web-based portal for state reports on Medicaid managed care; two additional state reporting templates related to Medical Loss Ratio (MLR) and network adequacy and access assurances; a new technical assistance toolkit for states to oversee access in MLTC programs; and recommended practices for ensuring timely and accurate payment to Indian health care providers.

The MLTC toolkit is intended as a resource for states to support program monitoring of access to services for Medicaid enrollees enrolled in MLTC plans. Entitled “Promoting Access in Medicaid and CHIP Managed Care: Managed Long-Term Services and Supports Access Monitoring Toolkit,” the resource was developed in response to MLTC growth and federal oversight concerns about access to services and quality in these programs. It includes federal regulation and guidance that establish access monitoring requirements, key data sources and strategies for monitoring MLTC access, and examples of how to apply these strategies to monitor access.

The new managed care reporting templates will provide a standard format for states to report managed care MLRs and network adequacy to CMS. To promote transparency in Medicaid and CHIP, the CMS bulletin also reminds states of the requirement to post their Network Adequacy and Access Assurances reports on a state website for each program they operate. All reports submitted to CMS will be made available after an initial review on a webpage at Medicaid.gov.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383