The Centers for Medicare and Medicaid Services (CMS) released its 2020 Medicaid & Children’s Health Insurance Program (CHIP) Managed Care Final Rule – CMS-2408-F in November. The Final Rule achieves a better balance between appropriate federal oversight and state flexibility while also maintaining critical beneficiary protections, ensuring fiscal integrity, and promoting accountability for providing quality care to people with Medicaid. The rule’s goal was to reduce federal regulatory barriers, support flexibility, and promote transparency and innovation when states develop and implement managed care programs for Medicaid and CHIP.
CMS Final Rule and Telehealth
The CMS final rule addresses telehealth specifically about how telehealth visits should be counted towards meeting a managed care plan’s network adequacy requirement. The TBHI blog published on November 14, 2020, has also discussed the list of new telehealth services covered by Medicare. The CMS rule states the following:
CMS also states in its press release that the adjustments it made to the minimum standards states must use in developing network adequacy requirements in a way that supports state facilitation for telehealth options. More specifically, the CMS final rule focuses on:
- Setting Actuarially Sound Capitation Rates
- Pass-Through Payments
- State-Directed Payments
- Network Adequacy Standards
- Risk Sharing Mechanisms
- Quality Rating System
- Appeals and Grievances
- Requirements for Beneficiary Information
The rule also gives states greater flexibility to establish appropriate payment for Medicaid and CHIP Services and set standards that effectively address the healthcare needs specific to their state while ensuring appropriate beneficiary protections. For more information on the CMS final rule, see CMS’ factsheet or read the rule in its entirety.