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This proposed rule would streamline the regulatory framework and provide burden reductions to ensure state Medicaid agencies are able to work effectively with CMS to design, develop, and deploy managed care programs that meet the state population’s needs.

Statement of Need:

This proposed rule would advance CMS’ efforts to streamline Medicaid and CHIP managed care and reflects a broader strategy to relieve regulatory burdens; support state flexibility and local leadership; empower the patient-doctor relationship in health care; and promote transparency, flexibility, and innovation in the delivery of care.

Summary of the Legal Basis:

Section 1102 of the Social Security Act (42 U.S.C. 1302).

Alternatives:

The HHS letter to the nation’s governors on March 14, 2017, committed to a review of the managed care regulations in order to prioritize beneficiary outcomes and State priorities. We are reviewing the managed care regulations in accordance with this commitment and recommending appropriate rulemaking.

Anticipated Costs and Benefits:

This proposed rule is intended to streamline the federal requirements for Medicaid and CHIP managed care. We anticipate that these changes will likely be economically significant.

Risks:

The current revisions of the regulations are intended to ensure that the regulatory framework is efficient and feasible for States to implement in a cost effective manner and address the risks identified in previous rulemaking. This would ensure that States operating State Medicaid and CHIP managed care programs can implement program and fiscal integrities without undue administrative burdens.