May 21, 2020

CMS Issues Medicaid Managed Care COVID-19 Flexibilities

The Centers for Medicare and Medicaid Services (CMS) released additional information during the week of May 11, 2020, for manners in which states may temporarily modify provider payment methodologies and capitation rates under their Medicaid managed care contracts.

The guidance provides several options that states can consider under their Medicaid managed care contracts, including the following:

  • Adjusting managed care capitation rates exclusively to reflect temporary increases in Medicaid fee-for-service (FFS) provider payment rates where an approved state-directed payment requires plans to pay FFS rates;
  • Requiring managed care plans to make certain retainer payments allowable under existing authorities to certain habilitation and personal care providers to maintain provider capacity and access to services; and
  • Utilizing state-directed payments to require managed care plans to temporarily enhance provider payment under the contract.

Where appropriate, CMS will also consider state requests to retroactively amend or implement risk mitigation strategies only for the purposes of responding to the COVID-19 public health emergency.