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- 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
- 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
- MAC QRS Initial Technical Resource Manual - Medicaid. gov
that contracts with managed care organizations (MCOs), prepaid inpatient health plans (PIHPs), or prepaid ambulatory health plans (PAHPs) to deliver Medicaid or CHIP services to establish a Medicaid and CHIP Quality Rating System (MAC QRS)—a state-run public website that provides quality information about Medicaid and CHIP managed care plans
- Medicaid and CHIP Managed Care Final Rules
The Centers for Medicare Medicaid Services (CMS) has updated regulations for Medicaid and CHIP Managed Care in 2016, 2017, 2020 and 2024 Information related to these regulatory updates are included below For questions regarding Managed Care, email ManagedCareRule@cms hhs gov
- Contract Review | Medicaid
The managed care regulation sets forth requirements for states to submit their contracts with managed care plans to the Centers for Medicare Medicaid Services (CMS) for review and approval
- 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
- Long-Term Services and Supports (LTSS) Quality Measures
Long-Term Services and Supports (LTSS) Quality Measures CMS is the measure steward for 15 nationally standardized LTSS quality measures including managed care and fee-for service (FFS) quality measures delivered by states through their Medicaid programs
- Managed Care in Puerto Rico - Medicaid. gov
Overview of Current Managed Care Programs Since 1994, Puerto Rico has mandated enrollment of most Medicaid beneficiaries, other income-eligible populations, and some government employees in managed care Originally called Reforma, renamed Mi Salud in 2010, the Government health Program (GHP) in 2015 and currently renamed Plan Vital since November 1, 2018 Puerto Rico’s Government Health Plan
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