Medicaid External Quality Review: An Updated Overview

Executive Summary

In 2016, the Centers for Medicare & Medicaid Services (CMS) updated Medicaid managed care regulations for the first time in over a decade. This included several new requirements for the External Quality Review (EQR) process. This issue brief reviews the updated EQR process and points out where States can take advantage of enhanced federal match to improve their managed care oversight in a cost-effective manner.

About this Series

This paper is part of a larger series that updates and expands NHeLP’s 2015 Advocates’ Guide to Oversight, Transparency, and Accountability in Medicaid Managed Care. Companion papers in this series include:

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