The Centers for Medicare and Medicaid Services plan to issue rules to bring reimbursements from Medicaid managed care plans to match rates set in fee-for-service systems , the agency announced on Thursday.
CMS has issued two announcements of proposed rulemaking that it says will promote access to care and promote price transparency. States will provide CMS with annual provider billing rate analyzes to compare Medicaid managed care and service fee payments with Medicare rates. State Medicaid agencies will also be required to publish rates on their websites.
“[The rules are] focus on increasing transparency and accountability of those administering the Medicaid program,” Health and Human Services Secretary Xavier Becerra said on a call with reporters. “We will standardize the data and do more monitoring so we can track it,” he said.
The upcoming draft regulations would require states to set standards for Medicaid payments to match Medicare reimbursements, which are often higher. This will allow CMS to accurately assess and compare Medicaid rates in every state, something it is currently unable to do, Medicaid Center Director Dan Tsai said on the call.
In addition to reporting payments for primary care, OB-GYN, and outpatient mental health and substance abuse services, states will be required to report total spending on provider reimbursements under state-directed payment arrangements. CMS will also require payments to be made within the contract timeframe instead of reconciling them later.
Insurers will be required to report the total costs and revenues from these payments to the states, which will then appear as line items on their annual medical loss ratio reports. states for CMS. States will also have to create consumer-friendly “one-stop” websites to allow beneficiaries to compare Medicaid plans.
The pending rules would also direct states to direct 80% of reimbursements for home and community services to direct care workers and standardize quality of publicity, compliance and reporting efficiency.
CMS also seeks to expand the application of benefits “in lieu of services and the environment” that use Medicaid funds to pay for non-medical assistance as a tool to address social determinants of health. Strong.
