HHS Provides States with Additional Resources to Improve Oversight and Ensure Access to Quality Care in Medicaid and CHIP Managed Care Programs



Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS) unveiled a suite of new resources to improve CMS and state oversight of Medicaid and Children’s Health Insurance Program (CHIP) managed care programs. These programs provide people with health benefits and additional services through contracted arrangements with managed care plans. Released in a Center for Medicaid and CHIP Services Informational Bulletin (CIB), this new information includes tools, templates, and updates on tactics to improve states reporting on their managed care programs, which promotes access to care for millions of people enrolled in Medicaid and CHIP.

“Today we are taking action to strengthen the oversight and transparency of Medicaid and CHIP-managed care programs,” said HHS Secretary Xavier Becerra. “We are working hand-in-hand with states and doubling down on our efforts to improve access to health care for the millions of Americans enrolled in these programs.”

“Ensuring access to health care for people enrolled in Medicaid and CHIP is a critical priority for the Biden-Harris Administration,” said CMS Administrator Chiquita Brooks-LaSure. “The tools we’re releasing today reflect the latest—and certainly not the last—step CMS is taking to increase transparency and ensure that people served through Medicaid and CHIP managed care programs are receiving high-quality, high-value care.”

Among other highlights, today’s CIB outlines the latest updates to a new web-based portal for state reporting on managed care programs to CMS. It also offers additional reporting templates and a new technical assistance toolkit, to help states improve their overall monitoring and oversight of managed care.

Recognizing the unique needs of Indian Health Care Providers, many of whom participate in managed care, the CIB also offers information about ensuring timely and accurate payment to such providers. To assist states in complying with specific protections for American Indian and Alaska Native communities, the CIB recommends specific practices and strategies to aid states and managed care plans in implementing statutory and regulatory Medicaid managed care protections for Alaska Natives and American Indians.

The managed care reporting templates released today will provide a standard format for states to report managed care medical loss ratios (a measure that helps encourage health plans to provide value to enrollees) and network adequacy (a measure of how well a plan delivers its actual benefits) to CMS. To promote transparency in Medicaid and CHIP, the CIB also reminds states of the requirement to post their Network Adequacy and Access Assurances reports on a state website for each program they operate. CMS will make all reports submitted through Managed Care Reporting available after an initial review of reports are complete. CMS will be creating a webpage on Medicaid.gov where states will be able to review the reports. Reports are currently available upon request.

As an additional step to aid states and the individuals many Medicaid and CHIP programs serve, CMS also released a toolkit to support program monitoring for Medicaid enrollees in Managed Long-Term Services and Supports (MLTSS) —specific managed care programs that can help ensure more people with long-term care needs transition from institutions to home and community-based settings. The toolkit, “Promoting Access in Medicaid and CHIP Managed Care: Managed Long-Term Services and Supports Access Monitoring Toolkit,” was developed in response to MLTSS growth and federal oversight concerns about access to services and quality-of-care.

Today’s CIB builds on a June 2021 informational bulletin, which provided a reporting template for the Annual Managed Care Program Report, announced the development of the web-based reporting portal, and released two technical assistance toolkits related to quality and behavioral health network adequacy for state use.

Improvements in health plan performance, care quality, and outcomes are key objectives of Medicaid and CHIP managed care programs. Over the last ten years, the majority of people with Medicaid and CHIP coverage were enrolled in managed care. Its increased use underscores the need for strong federal and state oversight, which is why resources like today’s CIB are key.

To view the Medicaid and CHIP Managed Care Monitoring and Oversight Tools CIB, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/cib07062022.pdf – PDF.