Fact Based List:

Avalere Health: 6 provisions of Medicaid Managed Care Proposed Rule

Submitted by Clive Riddle on Fri, 05/29/2015 - 16:08


  1. Medical Loss Ratio (MLR), including setting a minimum MLR for Medicaid managed care organizations.
  2. Standards to evaluate healthcare access, as well as a focus on the accuracy of network information that beneficiaries receive.
  3. Greater standardization of quality metrics across states and plans.
  4. Federal oversight of rate setting and a more detailed, regimented process for ensuring actuarial soundness.
  5. Continuity of care, including alignment of enrollment practices between Medicaid fee-for-service, Medicaid managed care organizations and exchange coverage.
  6. Stronger public reporting and transparency requirements for Medicaid managed care organizations and states.


Source: Becker's Hospital CFO
Source URL: http://www.beckershospitalreview.com/finance/6-projections-o...



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