Medicaid Program; Medicaid and Children's Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality

Proposed rule.

CFR Part: "42 CFR Parts 430, 438, and 457"

RIN Number: "RIN 0938-AU99"

Citation: "88 FR 28092"

Document Number: "CMS-2439-P"

Page Number: "28092"

"Proposed Rules"

Agency: "Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS)."

SUMMARY: This proposed rule would advance CMS' efforts to improve access to care, quality and health outcomes, and better address health equity issues for Medicaid and Children's Health Insurance Program (CHIP) managed care enrollees. The proposed rule would specifically address standards for timely access to care and States' monitoring and enforcement efforts, reduce burden for some State directed payments and certain quality reporting requirements, add new standards that would apply when States use in lieu of services and settings (ILOSs) to promote effective utilization and specify the scope and nature of ILOS, specify medical loss ratio (MLR) requirements, and establish a quality rating system for Medicaid and CHIP managed care plans.