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CMS Proposed Rule on Medicaid Managed Care (CRS Report for Congress)

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Release Date June 3, 2015
Report Number IF10234
Report Type In Focus
Source Agency Congressional Research Service
Summary:

On May 26, 2015, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule laying out the agency’s plan to update the federal regulations pertaining to Medicaid managed care, under which states contract with private health insurers to provide health care to enrollees. In general, federal agencies develop regulations to implement the laws passed by the Congress. CMS has that responsibility for Medicaid and the State Children’s Health Insurance Program (CHIP). This includes how states deliver services to Medicaid enrollees through risk-based managed care, the primary focus of the proposed rule. The proposed rule also addresses managed care in CHIP and third party liability (TPL) in Medicaid, but those topics are not the focus of this brief report.