Biden officials propose slate of Medicaid transparency changes

 The Biden administration on Thursday rolled out proposals to set national standards for care in Medicaid and children’s health care plans, amid upheaval for millions of Americans’ coverage in both programs.

A pair of draft rules released by federal health officials Thursday would require Medicaid plans to book enrollees for appointments within two weeks. The rules would also require states to track and report the quality of care patients receive, to share provider payment rates and to oversee these changes through “secret shopper” surveys.

However, while the agency proposed a slew of reporting requirements, the changes did not come with clear penalties or incentives for improving wait time and care.

The draft plans come as states reassess Medicaid and Children’s Health Insurance Program enrollment in the wake of the Covid-19 emergency. Congress allowed states to begin removing people from Medicaid rolls this month, ending a pandemic freeze that saw Medicaid coverage balloon with more than 20 million new enrollees. An estimated 18 million people could lose coverage in the next year, according to a KFF survey of state Medicaid programs.

Biden officials said during a briefing that the proposed changes would help bring Medicaid in line with similar rate reporting in Medicare and care expectations in commercial plans.

“We are proposing to line up a floor on appointment timeliness with what actually exists for commercial plans on the marketplace,” said Medicaid and CHIP Director Dan Tsai.

Also, if the rule is finalized, “every state has to benchmark their base rates for Medicaid relative to Medicare payment rates, which is a national standard that allows for comparison and easy benchmarking across states,” he said.

https://www.statnews.com/2023/04/27/medicaid-transparency/