The U.S. Centers for Medicare & Medicaid Services (CMS) said this week it has created a new unit within the CMS Center for Medicaid and CHIP Services (CMCS) to develop and manage federal Medicaid managed care policy.
CMS announced the Managed Care Group’s formation in a Federal Register notice Monday. John Giles is the group’s acting director.
The 340B program’s intersection with Medicaid managed care is a large and growing concern. More than 70% of the Medicaid and CHIP population nationally are enrolled in managed care plans. Drug manufacturers’ say their controversial conditions on 340B contract pharmacy arrangements are driven in part by their desire to reduce exposure to duplicate 340B discounts and Medicaid managed care rebates on the same drugs. California and New York state’s controversial transfers of Medicaid managed care drug benefits to Medicaid fee for service were driven in part, the states say, to address 340B program growth and associated reductions in state Medicaid rebate revenue.
CMS published a proposed rule late last month to make Medicaid managed care organizations use Medicaid-specific codes and group numbers on beneficiary insurance cards to help states, MCOs, and 340B covered entities avoid invoicing manufacturers for prohibited duplicate 340B discounts and Medicaid rebates on the same drugs. According to CMS’s June 5 Federal Register notice, the new Managed Care Group “provides national leadership in the development and management of Medicaid program policy and operations regarding managed care programs and provides technical assistance to states and other stakeholders.” Its duties also include reviewing Medicaid state plan amendments, waivers, and renewals “to ensure appropriate application of Medicaid managed care policy in state Medicaid programs.”