The writing is on the wall. There are well-documented issues of a lack of uniformity and accountability surrounding state Medicaid programs. Understanding CMS’s history of recognizing problems and acting to find solutions, it stands to reason the agency will, in the future, establish compliance programs for state Medicaid plans that mirror those of Medicare.

When CMS establishes greater control and oversight of Medicaid at the state level, government-sponsored health plans will have a new set of issues to work through in order to comply with the new regulatory guidance. The good news is these new regulations will most certainly mirror those already in effect for Medicare. Therefore, mirroring best practices in Medicare compliance today will better position health plans in the future.

Based on Medicare compliance programs, Medicaid plans can expect CMS to require increased operational reporting and increased compliance within the risk management function. To best prepare for rigorous compliance changes, Medicaid plans should:

Streamline process workflow

Conformity with CMS compliance guidance requires highly efficient communication and effective collaboration between a number of operative departments throughout a health plan. Marketing communications, compliance, IT, operations and medical management will need to coordinate their functional activities and reporting in order to comply with CMS standards. An effective process workflow that keeps everything running smoothly, on-time and in compliance is critical.

Enhance project management

Health plan member communications directors have the tough job of guiding collateral through a creation cycle that includes tracking multiple versions, pushing through numerous bottlenecks, dealing with multiple subject matter experts, ensuring regulatory compliance and setting up printing and delivery. An effective project management tool specifically designed for health plans can make things infinitely simpler and ensure materials are in compliance with CMS. This will also enable easier reporting when CMS audits are required.

Improve risk management

A robust risk management function will be essential for Medicaid plans required to detect, mitigate and alleviate risk throughout an organization. An organization’s risk management tool is key to compliance management as federal and state guidance evolves at a brisk pace.