HHS Announces New Tools to Bolster Oversight on Medicaid, CHIP Managed Care Programs

The US Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced new resources and programs to bolster federal and state oversight of Medicaid and CHIP plans, as well as care access for beneficiaries.

The new toolkits and updated tactics were released in a Center for Medicaid and CHIP Services Informational Bulletin (CIB), and HHS shared details in a press release.

“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,” said CMS Administrator Chiquita Brooks-LaSure.

To improve state reporting and oversight of managed care programs, the resources include updates to a new web-based portal for reporting, additional reporting templates, and a new technical assistance toolkit.

The new templates will allow states to report medical loss ratios and network adequacy to CMS in a standardized format. CMS will also make reports available after an initial review rather than upon request. States will be able to view all reports made through Managed Care Reporting on a new webpage on Medicaid.gov.

The CIB also includes information to aid timely, accurate payment for Indian Health Care providers, as well as recommendations for “implementing statutory and regulatory Medicaid managed care protections for Alaska Natives and American Indians,” the press release said.

Additionally, CMS announced the “Promoting Access in Medicaid and CHIP Managed Care: Managed Long-Term Services and Supports Access Monitoring Toolkit.” According to the press release, the toolkit is intended to improve program monitoring and address concerns over beneficiaries’ access to quality long-term care services.

The CIB expands on information provided in a June 2021 informational bulletin, which included a template for the Annual Managed Care Program Report, resources for states to oversee behavioral health network adequacy, and more.

“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,” said HHS Secretary Xavier Becerra.

Reference:
HHS provides states with additional resources to improve oversight and ensure access to quality care in Medicaid and CHIP managed care programs. News release. US Department of Health and Human Services; July 6, 2022.