CMS Releases Second Set of Medicaid; CHIP Managed Care FAQs

August 2017 ~

On August 18, CMS released its second set of frequently asked questions (FAQs) for the Medicaid and CHIP Managed Care Final Rule.

The second installment of this guidance addresses common questions related to payments to managed care organizations (MCOs) and prepaid inpatient health plans (PIHPs) for an enrollee that is a patient in an institution for mental disease (IMD).

Under last year’s Medicaid and CHIP Managed Care Final Rule, states may make capitated payments to managed care plans for enrollees aged 21 to 64 who have a short-term stay of no more than 15 days in an IMD, as long as the facility is an inpatient psychiatric hospital, substance use disorder inpatient care or sub-acute facility providing psychiatric or SUD crisis residential services.

The guidance clarifies the effective date of July 5, 2016 for impacted contracts and further clarifies that capitation payments are allowed for an enrollee that was a patient in an IMD for more than 15 days that spans consecutive months when each stay was not more than 15 days in the month.

The FAQs also includes supplementary information on the applicability of capitation payments under various short-term stay scenarios.

More information regarding Medicaid and CHIP Managed Care Final Rule can be viewed here.

Source(s):; Health Management Associates; Department of Health and Human Services;