NACDS comments on managed care in Medicaid, CHIP
ARLINGTON, Va. — The National Association of Chain Stores commented this week on the Centers for Medicare and Medicaid Services’ proposed regulations guiding the use of managed care in Medicaid and in the Children’s Health Insurance Program.
The comments would help “create standards that will serve to maintain the strong link between Medicaid patients and community pharmacies and the valuable services that these pharmacies provide,” according to a NACDS press release.
Managed care is a system of healthcare delivery that controls costs, the use of services and quality. More than 3-in-4 Medicaid and CHIP beneficiaries will be in managed care programs in 2016, up from 67% in 2013, Avalere Health reports.
NACDS focused its comments on six areas:
Covered Outpatient Drugs: NACDS commpented on preventing mandatory use of mail-order pharmacies, and preventing a reliance on closed networks for cutting-edge specialty medications.
Network Adequacy and Availability of Services: NACDS commented on advancing the belief that “patients should be allowed the freedom to select a pharmacy that best fits their personal health needs and provides the most accessible care,” particularly with mobility challenges faced by many Medicaid beneficiaries.
Program Integrity and Auditing: NACDS commented on recognizing the “balance between the need to ensure integrity in the Medicaid program and the need to afford due process and equal protection to providers.”
Medical Loss Ratio: NACDS commented on allowing medication therapy management (MTM) services to be considered as a healthcare activity, rather than an administrative cost, when calculating the ratio used to determine whether plans are spending adequately on patient care.
Provider Payment Initiatives: NACDS commented on incorporating innovative pharmacy services as part of managed care organizations’ strategies for delivering healthcare services.
Development of a Medicaid Managed Care Quality Rating System: NACDS commented on including appropriate medication-use metrics in healthcare quality ratings, and fostering consistency of these metrics across healthcare programs and across states.