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.
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:
- Medicaid External Quality Review: An Updated Overview (Nov. 2020)
- Finding and Analyzing Medicaid Quality Measures (Jan. 2021)
- Addressing Health Equity in Medicaid Managed Care Quality Oversight (May 2021)
- State quality fact sheets: Florida, Ohio
- Medicaid Managed Care: Using Sanctions to Improve Accountability (forthcoming)