Together, these rules from the Centers for Medicare & Medicaid Services (CMS), advance access to care, access to quality of care and aim to improve health outcomes across Medicaid fee-for-service (FFS) and managed care plans. The Access Rule addresses dimensions of access across both Medicaid FFS and managed care delivery systems, including increasing transparency and accountability, standardizing data and monitoring, and creating opportunities for states to promote beneficiary engagement. The Managed Care Rule addresses standards for timely access to care and states’ monitoring and enforcement efforts; quality and fiscal and program integrity standards for state directed payments; the scope of in lieu of services and settings; establishment of a quality rating system (QRS) for Medicaid and CHIP managed care plans.
Read more on access to medicaid services and CHIP.