|
- Managed Care | Medicaid
Managed 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 By contracting
- Guidance | Medicaid
Managed care technical assistance is available to assist state Medicaid agencies in developing, enhancing, implementing, and evaluating managed care programs Final Rules CMS has updated regulations for Medicaid and CHIP Managed Care in 2016, 2017, 2020 and 2024
- Medicaid and CHIP Managed Care Final Rules
This final rule is the first major update to Medicaid and the Children's Health Insurance Program (CHIP) managed care regulations in more than a decade See the related blog co-authored by the CMS Administrator and the Centers for Medicaid and CHIP Services (CMCS) Director, Medicaid Moving Forward
- Profiles Program Features | Medicaid
Profiles Program Features These Managed Care State Profiles and State Program Features reflect the most recently available managed care program information The State Profiles provide an overview of states' managed care program components and are intended to present a snapshot of each state's managed care landscape as of a given date
- 2025-2026 Medicaid Managed Care Rate Development Guide
Introduction The Centers for Medicare Medicaid Services (CMS) is releasing the 2025-2026 Medicaid Managed Care Rate Development Guide for use in setting rates for rating periods starting between July 1, 2025, and June 30, 2026, for managed care programs subject to the actuarial soundness requirements in 42 CFR § 438 4 3,4 This guidance is released in accordance with 42 CFR § 438 7(e) This
- Managed Care Entities | Medicaid
Federal Managed Care regulations at 42 CFR 438 recognize four types of managed care entities: Managed Care Organizations (MCOs) Comprehensive benefit package Payment is risk-based capitation Primary Care Case Management (PCCM) Primary care case managers contract with the state to furnish case management (location, coordination, and monitoring
- Managed Care Authorities | Medicaid
States can implement a managed care delivery system using three basic types of federal authorities:State plan authority [Section 1932 (a)]Waiver authority [Section 1915 (a) and (b)]Waiver authority [Section 1115]Regardless of the authority, states must comply with the federal regulations that govern managed care delivery systems These regulations include requirements for a managed care plan
- State Managed Care Quality Strategies | Medicaid
Federal regulations at 42 CFR § 438 340 for Medicaid, and through a cross-reference at § 457 1240 (e) for separate CHIP, lay the groundwork for the development and maintenance of a state managed care quality strategy to assess and improve the quality of managed care services offered within the state This quality strategy is intended to serve as a blueprint for states and their contracted
|
|
|