HCFA Publishes Medicaid Managed Care Rule with New Patient Protections
The Health Care Financing Administration ("HCFA") published
on January 19 a final rule intended to give States more flexibility in
administering Medicaid managed care provisions. DHHS said in a press
release that the new regulation, which implements provisions of the Balanced
Budget Act of 1997, fulfills President Clinton's promise to extend a
Patients' Bill of Rights to all Americans enrolled in public healthcare
programs.
The rule includes strengthened beneficiary protections and some new provisions
designed to protect Medicaid beneficiaries. The rule increases protections
for individuals with special healthcare needs, and requires managed care
plans serving Medicaid beneficiaries to provide consumers with comprehensive,
easy-to-understand plan information. Plans also must cover the cost of
emergency healthcare services wherever and whenever the need for such
services arises, and to screen and assess all enrollees of a health plan
within a certain time frame. The final rule establishes specific requirements
for state rate-setting of upper payment limits to ensure that all managed
care capitation rates are actuarially sound. Other protections include
increased access to services; prohibitions on gag rules; adoption of
a grievance and appeal system that addresses issues within certain time
frames; and new quality performance standards for States regarding health
plans.
The rule is effective on April 19. Read the final
rule in the January 19 Federal Register, 66 Fed. Reg. 6228. Also,
read the DHHS
press release on the rule.