On November 15, 2023, the Centers for Medicare & Medicaid Services released its proposed 2025 Notice of Benefit and Payment Parameters, the annual regulation which governs core provisions of the Affordable Care Act. This expert perspective focuses on aspects of the proposed rule likely to be of interest to state officials, including requirements for State-Based Marketplaces to align with the standards of the Federally Facilitated Marketplace, proposals for states to update essential health benefits, and initiatives to ease the eligibility and enrollment process for consumers.
Medicaid Managed Care Toolkit
State Medicaid agencies are increasingly turning to managed care organizations (MCOs) to cover more Medicaid enrollees, including those with complex needs. The ongoing shift from a fee-for-service payment model to a value-based payment model at the health plan and provider level puts even more importance on Medicaid managed care procurement strategies and approaches.
This webinar, drawn from the SHVS resource for states, Value-Based Purchasing for Managed Care Procurements: A Toolkit for State Medicaid Agencies, highlights key activities for state Medicaid agencies as they tackle managed care procurements. The webinar emphasizes the link between a state’s value objectives, RFP development, and model contract oversight. Beth Waldman and Mary Beth Dyer from Bailit Health discuss key steps and timelines for procurements, as well as important steps to take once contracts are in place to ensure a strong partnership between state Medicaid agencies and the health plans with which they contract. States with recent procurement experience will offer lessons learned from their own procurements.
Kim Hamilton, Director of the Managed Care Plan Division at Michigan Department of Health and Human Services shared with SHVS the provider survey implemented in Michigan and referenced during the webinar.