CMS’ Medicaid Managed Care Proposal Encourages EHR Use

May 28, 2015 in News

On Tuesday, CMS released a proposed rule for Medicaid managed care plans that would encourage states to provide funding to help health care providers who are excluded from the federal meaningful use program purchase electronic health record systems, Modern Healthcare reports.

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments (Conn, Modern Healthcare, 5/27).

Proposed Rule Details

The proposed rule would be the first update to Medicaid managed care rules in more than a decade. It aims to create more standardized practices across states and align managed care standards with those of the private market (Ferris, The Hill, 5/26).

Some of the rule’s provisions include:

  • Allowing beneficiaries enrolled in long-term care to change plans or disenroll and move to standard Medicaid coverage if their providers are out of managed care networks;
  • Creating standards to ensure beneficiaries can access adequate provider networks;
  • Implementing an 85% medical-loss ratio for insurers selling Medicaid managed care plans; and
  • Requiring states to give CMS enough information for the agency to understand plan payment rate data and the reasoning for the rates (Dickson, Modern Healthcare, 5/26).

Health IT Provisions

In addition, the proposed rule would allow managed care companies under contract with state Medicaid programs to count external quality reviews and other efforts related to health IT and meaningful use as integral services that add to the companies’ MLR. The proposed regulation states that CMS “encourage[s] states to support the adoption of certified technology that enables interoperability across providers and supports seamless care coordination for enrollees.”

Further, the proposed rule would allow states to provide “incentive payments for the use of technology that supports interoperable health information exchange by network providers that were not eligible for EHR incentive payments under the HITECH Act,” such as:

  • Behavioral health providers;
  • Home- and community-based providers; and
  • Long-term and post-acute care providers.

The proposed rule also would allow states to specify in contracts with managed care providers that the organizations must participate in “broad-based provider [HIE] projects,” as well as other programs that could bolster care quality.

The regulation also encourages managed care insurers, health care providers and vendors to use the Office of the National Coordinator for Health IT’s “best available standards” for health IT when implementing interoperable HIE for care coordination (Modern Healthcare, 5/27).

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