Medicaid Final Rule Contains Rate-Related Wins for MCOs

Two years after CMS proposed its long-awaited alternative to an “overly prescriptive” Obama-era Medicaid rule and just days after U.S. voters elected Joe Biden as their next president, the Trump administration on Nov. 9 issued the 2020 Medicaid & CHIP Managed Care final rule. For Medicaid managed care organizations, the rule contained several positives, such as clarifying how much states can adjust capitation rates during a rating period and prohibiting retroactive changes to risk-sharing mechanisms in MCO contracts, industry experts tell AIS Health.

The 289-page final rule finalized many policies contained in the Notice of Proposed Rule Making issued in November 2018, which was intended to reduce administrative burden, streamline the 2016 managed care regulatory framework and “promote transparency, flexibility, and innovation in the delivery of care” (RMA 11/15/18, p. 1). It was compiled with the input of a work group CMS formed with the National Association of Medicaid Directors and state Medicaid directors.

© 2024 MMIT
Lauren Flynn Kelly

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.

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