NAMD Says Medicaid Managed Care Rule Restricts Healthcare Reform

In response to the proposed regulations of Medicaid managed care, the National Association of Medicaid Directors (NAMD) submitted a list of comments to the Centers for Medicare & Medicaid Services (CMS), according to a statement made by Matt Salo, Executive Director NAMD, on July 28. In the comments, NAMD suggests that CMS create more flexibility surrounding the regulations to promote healthcare reform.

“Our main concern is that a number of significant pieces of the final rule will create an overly federalized framework that will hinder states from driving critical innovations and effectively tailoring their approaches to reflect the needs and expectations of the local populations and health care markets,” Salo wrote.

As reported by RevCycleIntelligence.com, the CMS managed care rule seeks to eliminate issues caused by the Affordable Care Act (ACA) and private healthcare markets, and ensure that patients are receiving the highest quality of care when switching from one form of healthcare to the next. The goal is to align Medicaid programs with private healthcare programs to create ease during transitions. The proposed rule also requires states to create new quality strategies for Medicaid and Children’s Health Insurance Program (CHIP), and would need to regularly meet standards for these.

NAMD states to CMS that it agrees that there is an intense need to bridge this gap between healthcare providers.

“In the years since the current regulation was promulgated, Medicaid managed care has changed and grown in many ways,” NAMD says to CMS. “There is a clear need to revise the existing regulatory framework to better reflect the dynamic nature of Medicaid managed care programs and the new role of this model in covering complex populations.”

The rules, which are intended to regulate the complexities for the Medicaid system and aid patients through its process, are so regulatory that states are inhibited in catering to the needs of their patients, according to NAMD. While NAMD recognizes that there certainly is a need to regulate the Medicaid system, it also also believes it’s important to strike the balance between overly rigid and allowing for program innovation.

NAMD says that the goals of CMS and Medicaid agencies should be twofold: ensuring that known best practices are implemented in all states, and ensuring that there is enough room left for each state to innovate what will work best for its individual Medicaid agency.

“This is a fine line and ultimately a moving target, and forced conformity through a federal lens effectively sets a ceiling on innovation and stifles the program’s growth,” Salo wrote. “A modern approach to the state-federal relationship around managed care must allow states to respond to fluctuations in local market and community needs, be forward-thinking in their operations, and foster innovations envisioned now and into the future.”

In order to allow states to respond to those fluctuations, NAMD says that regulations should allow room for states to respond to varying specific circumstances within their Medicaid programs and to begin and foster innovations for future stability.

NAMD also suggest that CMS communicate with those agencies administering Medicaid managed care programs in order to understand the specific needs of each individual state’s Medicaid program.

In the list of comments, NAMD also cites issues with the proposed rule such as how much the rule will cost to implement, whether CMS actually has the capacity to carry out these new policies, and the fact that this rule shifts power over Medicaid policy from the states to the federal government.

NAMD’s comments were a response to CMS’s call for improvements to their proposed rule.