Proposed Medicaid Managed Care Regulations: Guide to Implications for the Aging and Disability Network

Aging and Disability Partnership Guide to Medicaid Managed Care Proposed Rule

Prepared by: Justice in Aging, National Disability Rights Network, and Disability Rights Education and
Defense Fund.

For the first time in over a decade, the Centers for Medicare and Medicaid Services (CMS) is proposing to update the regulations for Medicaid services delivered by managed care organizations (MCOs).1 The long-term services and supports (LTSS) landscape continues to change, as more states are utilizing managed care for LTSS than ever before. The proposed regulations could introduce sweeping changes to the managed care delivery system and significantly impact community-based programs that provide LTSS services.
While there is extensive coverage of the proposed regulations in the general health policy world, a focus on the particular impact to community-based organizations is missing. This guide attempts to fill that gap, zeroing in on the potential changes to community-based programs under the proposed rule.

The guide focuses on eight key areas of importance to community-based organizations (CBOs) in the Aging and Disability Network:
1) Medical Loss Ratio and LTSS
2) Beneficiary Support System
3) Stakeholder Engagement
4) Enrollment and Disenrollment
5) Coverage and Continuation of Benefits Pending a Fair Hearing
6) Grievances and Appeal
7) Network Adequacy
8) Disability Accessibility