The Centers for Medicare & Medicaid Services has sent an overhauled set of rule changes to the Office of Management and Budget for review which could lead to major changes to the Medicaid program.
A key change would be the establishment of a minimum medical-loss ratio (MLR) of 85 percent. This means that at least 85 cents of every dollar of premium must be used for medical care, while the remaining 15 percent can go towards non-medical care related matters, including profits.
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The 653-page proposed version of the rule suggested the biggest changes in Medicaid managed-care regulations in more than a decade. It would cap insurer profits, require states to more rigorously supervise the adequacy of plans’ provider networks, encourage states to establish quality rating systems for plans, allow more behavioral healthcare in institutional settings and encourage the growth of managed long-term care.
The OMB review can take up to 90 days, which means the final rule could be published by mid- to late May, a year after it was proposed.
The proposed rule received nearly 900 comments by the July 27 comment deadline.
The full changes and rule can be found on CMS.gov.
Photo by Christian Schnettelker via Flickr CC License
