Feds probe how states set Medicaid managed care rates

In addition, the Centers for Medicare & Medicaid Services is planning its first major update of Medicaid managed care regulations in more than 15 years, reports Modern Healthcare.

Modern Healthcare: Actuarial Study Could Affect Medicaid Managed-Care Rates
The CMS has unveiled two initiatives that could significantly affect pay and operations for Medicaid managed-care plans and healthcare providers serving millions of low-income and disabled Americans. The agency has launched a study of the adequacy of how the states set payment rates to plans, which in turn affects the adequacy of reimbursements to providers, said Camille Dobson, a senior policy adviser at the CMS, at the Institute for International Research's Medicaid Managed Care Congress in Baltimore on May 21. The analysis involves Medicaid policy staff teaming with the CMS' Office of the Actuary to determine if payments are actuarially sound. ... In addition, the CMS is in the process of drafting a sweeping new rule that will update managed Medicaid regulations (Dickson, 5/27).