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CMS Issues Bulletin on Managed Care Regulations

The Centers for Medicare & Medicaid Services (CMS) has issued an informational bulletin on compliance enforcement for the Medicaid managed care final rule.

As states implement certain provisions of the final rule, CMS said it will use enforcement discretion dependent on state-specific facts. Such discretion will apply primarily to compliance deadlines for contracts beginning on or after July 1. States should work through their regional offices to identify regulations they will be unable to implement by the compliance deadline.

CMS will work with states to:

  • assess the goals of the regulation and each state’s past compliance with regulatory standards before the final rule; and
  • identify alternatives states should consider as they move toward compliance.

The informational bulletin notes that CMS will not grant flexibility on actuarial soundness and payment provisions, pass-through payment provisions, or medical loss ratio provisions.

Contact Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Rachel Schwartz is a former policy associate at America's Essential Hospitals.

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