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 2024_register executive 2024-05-10 article Part IV Rules and Regulations D09002ee1c6cc3424 D09002ee1c6cc34e8 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 will advance CMS's 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 final rule addresses standards for timely access to care and States' monitoring and enforcement efforts, reduces State burdens for implementing some State directed payments (SDPs) and certain quality reporting requirements, adds new standards that will apply when States use in lieu of services and settings (ILOSs) to promote effective utilization and that specify the scope and nature of ILOSs, specifies medical loss ratio (MLR) requirements, and establishes a quality rating system for Medicaid and CHIP managed care plans. 89 FR 41002 https://www.govinfo.gov/app/details/FR-2024-05-10/2024-08085 2024-08085 fr10my24-16 RIN 0938-AU99 4120-01-P CMS-2439-F https://www.govinfo.gov/app/details/FR-2024-05-10/2024-08085 https://www.govinfo.gov/content/pkg/FR-2024-05-10/html/2024-08085.htm https://www.govinfo.gov/content/pkg/FR-2024-05-10/pdf/2024-08085.pdf Administrative Practice and Procedure Grant Programs-Health Medicaid Reporting and Recordkeeping Requirements Citizenship and Naturalization Civil Rights Individuals with Disabilities Sex Discrimination Health Insurance 284 p. 41002 41285 89 FR 41002 Title 42 Part 430 42 CFR Part 430 Title 42 Part 438 42 CFR Part 438 Title 42 Part 457 42 CFR Part 457 RIN 0938-AU99 Medicaid Program; Medicaid and Children's Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality; Federal Register Vol. 89, Issue RULE 2024-08085 IV DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 2024-07-09 CMS-2439-F 4120-01-P 2024-08085 Final rule.

This final rule will advance CMS's 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 final rule addresses standards for timely access to care and States' monitoring and enforcement efforts, reduces State burdens for implementing some State directed payments (SDPs) and certain quality reporting requirements, adds new standards that will apply when States use in lieu of services and settings (ILOSs) to promote effective utilization and that specify the scope and nature of ILOSs, specifies medical loss ratio (MLR) requirements, and establishes a quality rating system for Medicaid and CHIP managed care plans.

Effective Dates: These regulations are effective on July 9, 2024. Rebecca Burch Mack, (303) 844-7355, Medicaid Managed Care. 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https://www.kff.org/medicare/issue-brief/how-much-more-than-medicare-do-private-insurers-pay-a-review-of-the-literature/ https://www.kff.org/womens-health-policy/issue-brief/medicaid-coverage-for-women/ https://www.macpac.gov/publication/june-2022-report-to-congress-on-medicaid-and-chip/ https://www.macpac.gov/wp-content/uploads/2017/04/Medicaid-Hospital-Payment-A-Comparison-across-States-and-to-Medicare.pdf https://www.macpac.gov/wp-content/uploads/2019/01/Physician-Acceptance-of-New-Medicaid-Patients.pdf https://www.macpac.gov/wp-content/uploads/2020/01/Health-Care-Related-Taxes-in-Medicaid.pdf https://www.macpac.gov/wp-content/uploads/2021/04/Medicaid-and-Rural-Health.pdf https://www.macpac.gov/wp-content/uploads/2022/06/Chapter-2-Oversight-of-Managed-Care-Directed-Payments-1.pdf https://www.macpac.gov/wp-content/uploads/2022/06/MACPAC_June2022-WEB-Full-Booklet_FINAL-508-1.pdf https://www.medicaid.gov/federal-policy-guidance/downloads/cib07062022.pdf 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