	Introduction

On May 26, 2015, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule (CMS-2390-P) that lays out the agency's plan to update the federal regulations pertaining to Medicaid managed care, under which states contract with private health insurers to provide health care to some enrollees. The proposed rule was posted to the Federal Register on June 1, 2015. The proposed rule would be the first major federal regulation impacting Medicaid managed care since 2002, and it would influence how states structure their managed care programs going forward. Many states rely on managed care organizations (MCOs) to deliver services to individuals newly eligible for Medicaid under the Patient Protection and Affordable Care Act's (ACA's; P.L. 111-148 , as amended) Medicaid expansion. With so many people getting Medicaid services through managed care, CMS is updating the regulations to better align them with today's health care landscape. This report responds to a series of frequently asked questions (FAQs) identified to address some of the major updates included in the proposed rule. The FAQs summarize provisions such as the introduction of a minimum medical loss ratio (MLR), guidance on enrolling the long-term services and supports (LTSS) population in managed care, and network adequacy. This report is not meant to be comprehensive and does not include all of the numerous technical changes CMS outlines in the proposed rule. Instead, this report provides a high-level summary of some of the major provisions in the proposed rule. Beginning in the early 1990s, states began turning more and more to managed care to deliver benefits to enrollees. In FY2011, 49.8% of Medicaid enrollees were enrolled in comprehensive risk-based managed care. Because of the high percentage of Medicaid enrollees receiving benefits through comprehensive risk-based managed care (delivered primarily through managed care organizations [MCOs]), the proposed rule is likely to impact millions of Medicaid enrollees. As of September 2014, 39 states had contracted with MCOs to deliver care to their Medicaid enrollees. The proposed rule would codify that guidance. The ACA established minimum MLRs for the private health insurance market and Medicare Advantage.
On May 26, 2015, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule (CMS-2390-P) laying out the agency's plan to update the federal regulations pertaining to Medicaid managed care, under which states contract with private health insurers to provide health care to some enrollees. The proposed rule was posted to the Federal Register on June 1, 2015.
The proposed rule would be the first major federal regulation impacting Medicaid managed care since 2002. In the early 1990s, states began turning to managed care to deliver benefits to enrollees. In FY2011, 49.8% of Medicaid enrollees were enrolled in comprehensive risk-based managed care. Many states rely on managed care organizations (MCOs) to deliver services to individuals newly eligible for Medicaid under the Patient Protection and Affordable Care Act's (ACA's; P.L. 111-148, as amended) Medicaid expansion. The proposed rule would influence how states structure their managed care programs going forward. As of September 2014, 39 states had contracted with MCOs to deliver care to their Medicaid enrollees. Because of the high percentage of Medicaid enrollees receiving benefits through managed care, the proposed rule likely would impact millions of Medicaid enrollees. With so many people receiving Medicaid services through managed care, CMS is updating the regulations to better align them with today's health care landscape, including the recent changes to Medicare Advantage and the private health insurance market (including the introduction of health insurance exchanges) as a result of the ACA.
This report responds to a series of frequently asked questions (FAQs) identified to address some of the major updates included in the proposed rule. The FAQs summarize provisions such as the introduction of a minimum medical loss ratio (MLR), guidance on enrolling the long-term services and supports (LTSS) population in managed care, and network adequacy. This report is not meant to be comprehensive and does not include all of the numerous technical changes CMS outlines in the proposed rule. Instead, this report provides a high-level summary of some of the major provisions in the proposed rule.
CMS is taking public comments on the proposed rule through July 27, 2015. Once the comment period closes, CMS will review the comments and make any changes before preparing a final rule. This report may be updated to include additional FAQs or more detailed answers on certain aspects of the proposed rule.