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Bookmark or Share- Rate Review and Rate Guides | MedicaidAddendum to the 2024-2025 Medicaid Managed Care Rate Development Guide CMS is releasing an Addendum to the 2024-2025 Medicaid Managed Care Rate Development Guide for states to accommodate the provisions of the Medicaid and Children’s Health Insurance Program Managed Care Access, Finance and Quality Final Rule(CMS-2439-F, 89 FR 41002 ...
- Medicaid and CHIP Managed Care ReportingThe Managed Care Program Annual Report is now available for state input in MDCT-Managed Care Reporting. As described in the Informational Bulletins, this report is required annually, and must be submitted through MDCT-Managed Care Reporting. More information about MDCT-Managed Care Reporting can be found below. Public Access to MLRs
- In Lieu of Services and Settings | MedicaidStates’ and managed care plans’ have the ability to cover services or settings that are substitutes for services or settings covered under the state plan as “in lieu of services and settings” (also known as ILOSs) in accordance with 42 CFR §§ 438.3(e)(2) and 438.16.
- Managed Care | MedicaidManaged Care is a health care delivery system organized to manage cost, utilization, and quality. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these services.
- Managed Care Quality Improvement | MedicaidFederal regulations at 42 CFR 438 subpart E (Quality Measurement and Improvement) require states with managed care contracts to carry out a set of managed care quality (MCQ) oversight activities, which include developing and updating state quality strategies (QS), establishing and implementing the state’s ongoing quality assessment and ...
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