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Bookmark or Share- Rate Review and Rate Guides | MedicaidIn January 2024, CMS released the 2024-2025 Medicaid Managed Care Rate Development Guide for states to use when setting rates with respect to any managed care program subject to federal actuarial soundness requirements during rating periods starting between July 1, 2024 and June 30, 2025. The guide provides detail around CMS' expectations of ...
- Medicaid and CHIP Managed Care QualityFederal regulations at 42 CFR §§ 438.350, 438.354, 438.358, 438.360, and 438.364 for Medicaid and through a separate cross-reference for CHIP at § 457.1250, set forth the parameters that states must follow when conducting an EQR of its contracted MCOs, PIHPs, and PAHPs, An EQR is the analysis and evaluation by an external quality review ...
- State Drug Utilization Review Reporting | MedicaidIn 2019, CMS released the FFS and Managed Care Organization (MCO) Surveys for FFY 2018 and at that time, CMS introduced the Medicaid Drug Programs (MDP) system, a more efficient way for CMS and states to manage DUR annual FFS and MCO surveys.
- Medicaid Managed Care State Guidetypes (i.e., MCO, PIHP, PAHP, NEMT PAHP, PCCM, PCCM entity, HIO) to which the requirement applies; 4) the governing statutory, regulatory, and/or other policy citation(s); and 5) the date by which CMS will enforce the contract requirement. Sections II and III . of this guide provide additional resources to help states in their contract development
- 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.
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