Federal Managed Care Regulations
On April 25, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the Medicaid and CHIP Managed Care Final Rule (2016 Final Rule), which aligns the Medicaid managed care program with other health insurance coverage programs in several key areas:
- Modernizes how states purchase managed care for beneficiaries;
- Adds key consumer protections to improve the quality of care and beneficiary experience; and
- Improves state accountability and transparency.
The 2016 Final Rule was the first significant overhaul of the federal Medicaid managed care regulations since 2002, and was a response to the predominant shift to Medicaid managed care delivery system occurring nationwide. The 2016 Final Rule was effective July 5, 2016 with a phased implementation over several years.
In California, the 2016 Final Rule regulations are applicable to Medi-Cal Managed Care Plans, County Mental Health Plans, Drug Medi-Cal Organized Delivery System, and Dental Managed Care Plans. This webpage contains posting requirements for the Quality Strategy, Network Adequacy, and Mental Health Parity components of the 2016 Final Rule.
On November 14, 2018, CMS published a notice of proposed rulemaking (NPRM) entitled “Medicaid Program; Medicaid and Children’s Health Insurance Plan (CHIP) Managed Care.” On January 14, 2019, DHCS submitted a comment letter to CMS on the NPRM.