Medicaid Proposal Updates Managed Care Rules In comments, ASHA raises issues of quality measures, continuity of care, provider enrollment and other topics. Policy Analysis
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Policy Analysis  |   August 01, 2015
Medicaid Proposal Updates Managed Care Rules
Author Notes
  • Laurie Alban Havens, MA, CCC-SLP, is director of ASHA private health plans and Medicaid advocacy. lalbanhavens@asha.org
    Laurie Alban Havens, MA, CCC-SLP, is director of ASHA private health plans and Medicaid advocacy. lalbanhavens@asha.org×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   August 01, 2015
Medicaid Proposal Updates Managed Care Rules
The ASHA Leader, August 2015, Vol. 20, 26. doi:10.1044/leader.PA.20082015.26
The ASHA Leader, August 2015, Vol. 20, 26. doi:10.1044/leader.PA.20082015.26
Proposed regulations for managed care programs under Medicaid and the Children’s Health Insurance Program (CHIP) would create more uniformity among state programs while improving beneficiary choices and quality.
Issued in late May by the Centers for Medicare and Medicaid Services (CMS), the proposal updates 2002 regulations for managed care organizations. Estimates indicate that managed care enrollment in Medicaid—the largest payer of health care services in the United States—has jumped 48 percent to 46 million beneficiaries, and that almost three-quarters of Medicaid beneficiaries will be enrolled in managed care organizations by the end of 2015.

Almost three-quarters of Medicaid beneficiaries will be enrolled in managed care organizations by the end of 2015.

As a result of this growth, audiologists and speech-language pathologists are providing services to greater numbers of patients covered by Medicaid and CHIP managed care organizations. ASHA’s comments to CMS on the proposal address several issues that affect audiologists and SLPs who participate—or are interested in participating—as providers in Medicaid managed care plans.
  • Alignment of plans. Because people often move among insurers, ASHA is requesting that eligibility standards for managed care programs be the same as those for other payers, such as traditional Medicaid and Medicaid expansion plans and the plans that are part of the health insurance exchanges. With standardized enrollment qualifications, a patient leaving one plan would likely qualify for another.

  • Network adequacy. Managed care organizations should be required to update their network or providers regularly, to ensure sufficient providers to meet enrollees’ needs and to allow audiologists and SLPs who want to participate to enroll as spaces become available.

  • Quality improvement. CMS should institute methods that adequately measure the quality of speech-language and hearing services, rather than using measures developed for other disciplines.

  • Continuity of care. When beneficiaries qualify for both Medicare and Medicaid, managed care plans should ease the change from or among multiple payers by minimizing the wait for treatment approval from the new providers.

  • Appeals. CMS should streamline the process for beneficiaries who want to appeal plan decisions to deny services. Historically, the timeframe to appeal denied claims has been limited, although payers have been allowed more time to provide a response.

ASHA will provide more information on the effects of the regulations when the final rule is issued sometime later this year.
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August 2015
Volume 20, Issue 8