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CHA Issues Summary of Medicaid Managed Care Final Rule

For CEOs, CFOs, finance & reimbursement staff, government relations executives

CHA has issued a detailed summary, prepared by Health Policy Alternatives, of the Medicaid Managed Care final rule recently issued by the Centers for Medicare & Medicaid Services. 

The summary details the revised policy and technical changes to Medicaid and Children’s Health Insurance Program managed care regulations, including setting capitation rates, pass through payments, directed payments, network adequacy standards, risk sharing mechanisms, quality rating systems, appeals and grievances, and requirements for beneficiary information. 

Most of the rule’s provisions are effective Dec. 14. Regulations permitting transitional pass-through payments and rate ranges become effective for rating periods starting on or after July 1, 2021.