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- 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
- Drug Utilization Review Annual Report | Medicaid
On an annual basis, states are required to report on their practitioners prescribing habits, cost savings generated from their Drug Utilization Review (DUR) programs and their program’s operations, including adoption of new innovative DUR practices via the Medicaid Drug Utilization Review Annual Report Survey Please visit the Drug Utilization Review page for more inf
- Medicaid Managed Care State Guide
January 18, 2022 This guide covers the standards that are used by the Centers for Medicare Medicaid Services (CMS) Division of Managed Care Operations (DMCO) staff to review and approve State contracts with Medicaid managed care organizations (MCOs), prepaid inpatient health plans (PIHPs), prepaid ambulatory health plans (PAHPs), non-emergency medical transportation prepaid ambulatory health
- 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)
- 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
- Medicaid and CHIP Managed Care Quality
Many states deliver services to Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries via managed care arrangements
- Section 71115 and 71117 of WFTCL - Medicaid. gov
The transition period policy discussed in this letter represents the minimum transition period (in the case of MCO taxes that exploit the loophole) that states will have to bring non-compliant tax waivers into conformity with the requirements added by section 71117 of WFTCL
- Medicaid Managed Care Enrollment and Program Characteristics 2022
Because Medicaid beneficiaries may be concurrently enrolled in more than one type of managed care program (e g , a Comprehensive MCO and a BHO), users should not sum enrollment across all program types, since the total would count individuals more than once and, in some states, exceed the actual number of Medicaid enrollees
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