“CMS says that states should reimburse Medicaid managed care plans for the Affordable Care Act’s health insurance provider fee, and says that the fee itself should be incorporated into plans’ capitation rates, however, as the firm JP Morgan notes, the agency leaves some “wiggle room” on whether states should also factor in other potential effects of the fee, such as its non-deductibility status. Medicaid Health Plans of America President Jeff Myers said CMS’ recently released frequently asked questions document provides certainty for plans, particularly in states that hadn’t yet agreed to cover those fees.
Myers said the plans are gratified CMS decided to move forward with the FAQ, and the release of the FAQ and the 2015 Managed Care Rate Setting Consultation guide suggest that CMS would like to play a more involved role in rate setting for managed care. Since plans have been asking for more transparency around rate setting, CMS’ involvement could be a net positive, Myers said. The Government Accountability Office has also said that CMS’ oversight of the rate-setting process needs improvement.”