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- August 21, 2014
Recommendations for the Modernization of the Federal Medicaid Regulations
Read moreMedicaid managed care has changed significantly over the past decade and includes more vulnerable people who have disabilities, are older, or have limited English proficiency than ever before. Service delivery methods have evolved and technology advanced. Yet the managed care regulations have not been updated since 2002. These modernized…
- August 19, 2014
Managed Care in CA Series, Issue 1: Network Adequacy Laws (Revised May 7, 2018)
Read moreManaged Care and California Series Issue 1: Medi-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…
- August 19, 2014
Managed Care in California Series, Issue 2: Network Adequacy Laws in Covered California Plans
Read moreManaged Care and California Series Issue 2: Covered California QHPs receive a set premium payment ("capitation") per enrollee in exchange for providing services. The plans accept the risk of incurring a loss if they spend more on services than they receive through the premium payments, but they will make…
- 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…
