July 1, 2016
On April 25, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule on managed care in Medicaid and the Children’s Health Insurance Program (CHIP). Since over a decade, the rule is intended to deliver managed long-term supports and services (MLTSS).
The final rule establishes an independent beneficiary support system designed to help managed care beneficiaries navigate the delivery system for their MLTSS, as well as requiring MLTSS providers to use person-centered planning when determining which services they will cover to ensure for each beneficiary’s interests, choices, and desire for independence. As MLTSS providers and provider networks will be monitored for provider accessibility, credentials, and qualifications, the changes to the MLTSS system are made to improve the various different types of LTSS delivered under managed care, potentially reducing the risk of “one-size-fits-all” plans.