HHS Issues Final Rule to Overhaul Medicaid and CHIP Managed Care

On Monday the Department of Health and Human Services (HHS) issued a final rule to overhaul managed care in the Medicaid and Children’s Health Insurance Program (CHIP) systems.

The final rule has four key goals, according to HHS:  (1) supporting states’ efforts to advance delivery system reform and improvements in quality of care for Medicaid and CHIP beneficiaries; (2) strengthening the consumer experience of care and key consumer projections; (3) strengthening program integrity by improving accountability and transparency; and (4) aligning rules across health insurance coverage programs to improve efficiency and help consumers who are transitioning between sources of coverage.

“Medicaid improves the health, well-being, and financial security of millions of Americans,” said Vikki Wachino, director of the Center for Medicaid and CHIP Services. “These new rules will help Medicaid continue to be a leader in providing high-quality care to diverse populations with diverse health needs.”

To support states’ efforts to advance delivery system reform and improve quality, the rule also establishes Medicaid’s first Quality Rating System and clarifies states’ authority to enter into contracts that pay plans for quality or encourage participation in alternative payment models and other delivery system reform efforts.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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