United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2016_register executive 2016-05-06 article Part II Rules and Regulations D09002ee1c7f6386d D09002ee1c7f6398c United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Centers for Medicare & Medicaid Services originator org United States Government Agency or Subagency This final rule modernizes the Medicaid managed care regulations to reflect changes in the usage of managed care delivery systems. The final rule aligns, where feasible, many of the rules governing Medicaid managed care with those of other major sources of coverage, including coverage through Qualified Health Plans and Medicare Advantage plans; implements statutory provisions; strengthens actuarial soundness payment provisions to promote the accountability of Medicaid managed care program rates; and promotes the quality of care and strengthens efforts to reform delivery systems that serve Medicaid and CHIP beneficiaries. It also ensures appropriate beneficiary protections and enhances policies related to program integrity. This final rule also implements provisions of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) and addresses third party liability for trauma codes. 81 FR 27498 https://www.govinfo.gov/app/details/FR-2016-05-06/2016-09581 2016-09581 fr06my16-15 RIN 0938-AS25 4120-01-P CMS-2390-F https://www.govinfo.gov/app/details/FR-2016-05-06/2016-09581 https://www.govinfo.gov/content/pkg/FR-2016-05-06/html/2016-09581.htm https://www.govinfo.gov/content/pkg/FR-2016-05-06/pdf/2016-09581.pdf Grant Programs-Health Health Facilities Medicaid Privacy Reporting and Recordkeeping Requirements Administrative Practice and Procedure Child Support Claims Health Insurance Electronic Health Records Health Professions Health Maintenance Organizations (Hmo) Medicare Penalties 404 p. 27498 27901 81 FR 27498 Title 42 Part 431 42 CFR Part 431 Title 42 Part 433 42 CFR Part 433 Title 42 Part 438 42 CFR Part 438 Title 42 Part 440 42 CFR Part 440 Title 42 Part 457 42 CFR Part 457 Title 42 Part 495 42 CFR Part 495 RIN 0938-AS25 Medicaid and Children's Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, and Revisions Related to Third Party Liability; Federal Register Vol. 81, Issue RULE 2016-09581 II DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 2016-07-05 CMS-2390-F 4120-01-P 2016-09581 Final rule.

This final rule modernizes the Medicaid managed care regulations to reflect changes in the usage of managed care delivery systems. The final rule aligns, where feasible, many of the rules governing Medicaid managed care with those of other major sources of coverage, including coverage through Qualified Health Plans and Medicare Advantage plans; implements statutory provisions; strengthens actuarial soundness payment provisions to promote the accountability of Medicaid managed care program rates; and promotes the quality of care and strengthens efforts to reform delivery systems that serve Medicaid and CHIP beneficiaries. It also ensures appropriate beneficiary protections and enhances policies related to program integrity. This final rule also implements provisions of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) and addresses third party liability for trauma codes.

Except for 42 CFR 433.15(b)(10) and Sec. 438.370, these regulations are effective on July 5, 2016. The amendments to Sec. Sec. 433.15(b)(10) and 438.370, are effective May 6, 2016. Nicole Kaufman, (410) 786-6604, Medicaid Managed Care Operations. Grant Programs-Health Health Facilities Medicaid Privacy Reporting and Recordkeeping Requirements Administrative Practice and Procedure Child Support Claims Health Insurance Electronic Health Records Health Professions Health Maintenance Organizations (Hmo) Medicare Penalties Medicaid and Children's Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, and Revisions Related to Third Party Liability , Healthcare.gov http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SHO083109a.pdf http://innovation.cms.gov/Files/reports/MEPD_RTC.pdf http://oig.hhs.gov/fraud/docs/alertsandbulletins/SABGiftsandInducements.pdf http://www.access-board.gov/sec508/guide/index.htm http://www.actuarialstandardsboard.org/wp-content/uploads/2015/03/asop049_179.pdf http://www.ahrq.gov/professionals/prevention-chronic-care/improve/coordination/index.html http://www.cdc.gov/ncbddd/disabilityandhealth/types.html 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http://www.medicaid.gov/federal-policy-guidance/downloads/SMD15003.pdf http://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/downloads/1115-and-1915b-mltss-guidance.pdf http://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/downloads/cmcs-eqr-protocols.pdf http://www.medicaid.gov/medicaid-chip-program-information/by-topics/financing-and-reimbursement/downloads/medicaid-actuarial-report-2013.pdf http://www.medicaid.gov/medicaid-chip-program-information/by-topics/financing-and-reimbursement/downloads/medicaid-actuarial-report-2014.pdf http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Home-and-Community-Based-Services/Home-and-Community-Based-Services.html http://www.ncbi.nlm.nih.gov/pubmed/17517112 http://www.pasrrassist.org/sites/default/files/attachments/10-07-23/ManagedLTSS.pdf http://www.qualityforum.org/setting_priorities/partnership/measure_applications_partnership.aspx http://www.urban.org/sites/default/files/alfresco/publication-pdfs/412901-Medicaid-CHIP-Participation-Rates-Among-Children-An-Update.pdf http://www.w3.org/TR/WCAG20/ https://downloads.cms.gov/cmsgov/archived-downloads/CMCSBulletins/downloads/payment-suspensions-info-bulletin-3-25-2011.pdf https://innovation.cms.gov/Files/reports/MEPD_RTC.pdf https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Health-Insurance-Marketplace-Quality-Initiatives.html https://www.federalregister.gov/articles/2015/11/02/2015-27696/medicaid-program-request-for-information-rfi-data-metrics-and-alternative-processes-for-access-to https://www.healthit.gov/sites/default/files/2016-interoperability-standards-advisory-final-508.pdf https://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-version-1.0.pdf https://www.healthit.gov/standards-advisory/2016 https://www.macpac.gov/wp-content/uploads/2015/01/MACFacts-UPL-Payments_2012-11.pdf https://www.medicaid.gov/federal-policy-guidance/downloads/SMD15003.pdf https://www.medicaid.gov/federal-policy-guidance/federal-policy-guidance.html https://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/prescription-drugs/downloads/dursurvey_20140617.pdf https://www.medicaid.gov/medicaid-chip-program-information/by-topics/data-and-systems/medicaid-managed-care/medicaid-managed-care-enrollment-report.html https://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/managed-care/downloads/2016-medicaid-rate-guide.pdf https://www.medicaid.gov/medicaid-chip-program-information/by-topics/financing-and-reimbursement/accountability-guidance.html https://www.medicaid.gov/medicaid-chip-program-information/by-topics/financing-and-reimbursement/expenditure-reports-mbes-cbes.html https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Quality-of-Care-External-Quality-Review.html https://www.sba.gov/contracting/getting-started-contractor/make-sure-you-meet-sba-size-standards/summary-size-standards-industry-sector Medicaid.gov www.bls.gov/oes/current/oes_nat.htm www.hhs.gov/ocr www.lep.gov www.Medicaid.gov Vol. 81, no. 88 Office of the Federal Register, National Archives and Records Administration 2016-05-06 continuing daily deposited born digital 697 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2016-05-06 P0b002ee18f608c5a 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr06my16 https://www.govinfo.gov/app/details/FR-2016-05-06 https://www.govinfo.gov/content/pkg/FR-2016-05-06/pdf/FR-2016-05-06.pdf https://www.govinfo.gov/content/pkg/FR-2016-05-06/xml/FR-2016-05-06.xml fdlp 27295 27982 DGPO 2016-05-06 2024-06-02 FR-2016-05-06 machine generated eng FR FR-2016-05-06 81 88