January 9, 2023
The Centers for Medicare & Medicaid Services (CMS) released guidance to clarify how states can use an existing Medicaid managed care option to reduce health disparities and address unmet health-related social needs. A managed care final rule that was enacted under the 2016 Medicaid and Children's Health Insurance Program allows states and managed care plans to request approval from CMS to cover alternative services and settings in which they are provided. The guidance provides details on the policy framework and CMS' expectations for proposals to meet health-related social needs. Click here to read this guidance.
"CMS' guidance allows Medicaid agencies to pay for nonclinical services such as housing, nutrition and transportation that would reduce health costs by preventing adverse health events. States must determine such services are appropriate and a cost-effective substitute for medical care. It requires such substitutes, known as in-lieu-of services, be written into managed care contracts and considered when determining payment to private insurers," as explained in Modern Healthcare (January 4, 2023). Click here to read this article.