A proposed new CMS rule to govern increasingly popular Medicaid managed-care plans encourages states to fund the purchase of electronic health-record systems for behavioral health, long-term care and other providers previously excluded from federal EHR incentive payments. The draft regulation also promotes health information exchange.
The 653-page proposed rule (PDF) released Tuesday is the first update of Medicaid managed-care regulations since 2003.
Managed-care companies that contract with state Medicaid programs would be able to count activities that improve healthcare quality, such as external quality reviews and efforts “related to health information technology and meaningful use," as core services that contribute to their medical loss ratio.
A medical loss ratio, or MLR, requires health plans to spend a minimum portion of the rates they receive on medical services as opposed to administrative costs and profits. The proposed Medicaid rule recommends that states impose an MLR of 85% in their managed-care plans.
“(W)e encourage states to support the adoption of certified technology that enables interoperability across providers and supports seamless care coordination for enrollees,” the proposed rule said.
Since 2011, the federal EHR incentive payment program has provided more than $30 billion to encourage hospitals, office-based physicians and other “eligible professionals to adopt and meaningfully use EHRs. But the so-called HITECH provisions of the 2009 American Recovery and Reinvestment Act that created the program excluded many other providers, such as long-term-care organizations, from eligibility.
States, according to the rule, “could make available incentive payments for the use of technology that supports interoperable health information exchange by network providers that were not eligible for EHR incentive payments under the HITECH Act (for example, long-term/post-acute care, behavioral health and home and community based providers.”
States also may specify in their contracts with managed care organizations and other advantage plans that they participate in “broad-based provider health information exchange projects” among other quality improvement programs.
Providers, payers and vendors also are encouraged to take “best available standards” from the Office of the National Coordinator for HIT into account as they implement interoperable health information exchange across the continuum of care.
According to the CMS, in 1992 only 8% of Medicaid beneficiaries were covered by capitated health plans, but by 2011, 58% were, with plans being made available in 39 states and the District of Columbia.
