Somehow stroke survivors will need to be some of the voices in setting standards for stroke care. We can't let doctors do this because they will just propose guidelines, not RESULTS. That would be ensuring stroke rehab failures for decades.
http://www.medpagetoday.com/PublicHealthPolicy/Medicaid/57533?
WASHINGTON -- States will need to establish network adequacy standards for Medicaid managed care providers under a final rule issued Monday by the Centers for Medicare and Medicaid Services (CMS).
"Today's final rule has four goals: supporting states' efforts to
advance delivery system reform; strengthening the consumer experience of
care; strengthening program integrity; and aligning rules across health
insurance coverage programs to improve efficiency and help consumers,"
said Vikki Wachino, MPP,
director for the Center for Medicaid and CHIP Services at CMS, on a
conference call. As part of those goals, "Our final rule requires states
to establish network adequacy standards, and to establish time and
distance standards for primary care physicians, behavioral health
providers, pharmacy providers, and pediatric dentists."
The
rule also requires network adequacy standards for specialists, but
leaves it up to states to decide which specialists and what the
standards will be. "We agree with commenters that states should define
this category and set network adequacy standards that are appropriate at
the state level," the final rule stated.
"We believe that allowing states to define the 'specialist' category
better reflects the needs of their respective programs, and we believe
it would be inappropriate for CMS to define this standard at the federal
level. We also believe that states are in the best position to engage a
variety of stakeholders when defining the 'specialist' category and
setting appropriate network adequacy standards for such defined
'specialist' providers. We specifically encourage states to be
transparent in this process."
States must comply with the network adequacy requirements "no later
than the rating period for Medicaid managed care contracts starting on
or after July 1, 2018," according to the rule.
The 1,424-page rule also establishes the program's first-ever quality
rating system, and "requires additional transparency on how Medicaid
rates are set to help ensure fiscal integrity of the Medicaid managed
care program, including data on utilization and quality of services,"
Wachino said.
In addition, it "sets medical loss ratios for Medicaid managed care
plans and better aligns reporting of medical loss ratios with Medicare
Advantage and the marketplace. This will improve the experience for
people who transition between coverage programs, and eases the burden on
providers who participate in several programs."
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