Medicaid program; Medicaid managed care--HCFA. Proposed rule.
This proposed rule would amend the Medicaid regulations to allow the States greater flexibility by giving them the option to require Medicaid recipients to enroll in managed care entities without obtaining waivers. These revisions, which are authorized by the Balanced Budget Act of 1997, would establish new beneficiary protections in areas such as quality assurance, grievance rights, and coverage of emergency services. They would eliminate certain requirements viewed by State agencies as impediments to the growth of managed care programs, such as the enrollment composition requirement, the right to disenroll without cause at any time, and the prohibition against enrollee cost-sharing. They would also permit State agencies to amend their State plans to require enrollment in managed care organizations subject to certain conditions, including limits on whose enrollment can be mandated, and a requirement for beneficiary choice. In addition, this rule would extend most of these new requirements to prepaid health plans.
D014487:Centers for Medicare and Medicaid Services, U.S.; D008329:Managed Care Programs / Q000191:economics / Q000331:legislation & jurisprudence*; D008484:Medicaid / Q000331:legislation & jurisprudence*; D017061:Prepaid Health Plans / Q000191:economics / Q000331:legislation & jurisprudence; D013221:State Health Plans / Q000331:legislation & jurisprudence*; D014481:United States