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July 5: Immediate Changes to Medicaid Managed Care

June 27, 2016

On July 5, the first wave of new Medicaid managed care regulation requirements go into effect. The Centers for Medicare and Medicaid Services (CMS) published the final Medicaid managed care rule this spring, introducing sweeping changes to how the federal government will regulate the entities that manage long-term services and supports (LTSS). While many of regulation’s big ticket items will be implemented over the course of the year, a few important pieces go live this summer. Justice in Aging will discuss these changes in a free webinar on June 30. Here’s a short list of some of the items we’ll be discussing.

Definition of long-term services and supports (LTSS)
Until now, federal Medicaid managed care regulations have not defined long-term services and supports. On July 5, a new definition goes into effect, clarifying the primary role of LTSS as supporting individuals as they live or work in the setting of their choice.

Protections against discrimination
As of next week, the regulation’s clear ban against enrollment discrimination goes into effect. Under this ban, managed care organizations (MCOs) cannot discriminate against any individuals who are eligible to enroll in the managed care plan on the basis of race, color, national origin, sex, sexual orientation, gender identity, or disability. Importantly, the MCOs cannot use any policy or practice that has the effect of discrimination on the basis of race, color, or national origin, sex, sexual orientation, gender identity, or disability.

Sharing information about advance directives
In a helpful move toward advance care planning, the regulation requires MCOs to provide individuals with information about advance directive policies.

Right to provider choice
A requirement that each individual has a right to choose his or her network provider, “to the extent possible and appropriate,” goes into effect on July 5. During our webinar, we will discuss how this immediate change works with the regulation’s more long-term network adequacy improvements.

Promoting cultural competency
The regulation includes direct guidance to states, including the requirement that states have methods to protect beneficiary access to services delivered in a manner that meets their needs. The regulation clarifies this includes delivering services in a culturally competent manner, particularly to individuals with limited English proficiency, diverse cultural and ethnic backgrounds, disabilities, and cognizant of gender, sexual orientation, and gender identity.

We’re looking forward to parsing out the meaning of all of this and putting it into context with the overall regulation changes during our webinar on June 30. We hope you’ll join us!

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