Medicaid MCOs Have ‘Quite A Lift’ to Meet New Access, Quality Rules

May 24

Medicaid managed care plans are going to invest significant money and time in making sure they comply with CMS’s recently released final rule pertaining to access, finance and quality, according to executives from consulting firm Sellers Dorsey who spoke during a May 20 webinar. Karen Brach, a Sellers Dorsey managing director and former health insurer executive, said “plans have quite a lift ahead of them,” although she added the rule presents a “tremendous opportunity for collaboration” among state Medicaid programs, plans and providers.

The final rule, which was published in the Federal Register on May 10, updates access and quality standards that were established in 2016 and 2020. It was released on the same day as another final rule addressing broader access issues, including requirements for home- and community-based services and fee-for-service Medicaid programs. Earlier this year, CMS announced a final rule on prior authorization and interoperability in Medicaid and a final rule on Medicaid eligibility and enrollment.

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Tim Casey

Tim has been a reporter and editor for newspapers, websites and magazines for more than 20 years, including 10 years covering health care business topics. He has a deep knowledge of the managed care industry and pharmacy benefit management. He also has experience covering medical conferences and clinical and legislative health care issues. In 2014, the Society for Advancing Business Editing and Writing selected Tim as one of 15 journalists to participate in a national symposium on the Affordable Care Act. Tim has a B.A. in Psychology from the University of Notre Dame and an M.B.A. from Georgetown University.