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… results in Managed Care.
- June 16, 2014
External Quality Review: An Overview
Read morePart of the overall quality strategy mandated by the Medicaid Act and regulations requires states to include annual independent external quality reviews (EQRs) in each managed care contract. This approach requires an independent organization to validate state selected performance measures, perform site visits and "otherwise evaluate the performance of…
- May 8, 2014
Network Adequacy Laws in Medi-Cal Managed Care Plans
Read moreMedi-Cal managed care plans are capitated, meaning they receive a set payment per enrollee per month in exchange for providing services.The plans contract on a "comprehensive risk" basis, which means they accept the risk of incurring a loss if they spend more on services than they receives through the…
