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- 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…
- March 18, 2014
NHeLP Comments to 2015 Letter to Issuers in FFMs
Read moreThese are NHeLP comments to the 2015 Letter to Issuers in a federally-facilitated marketplace. The comment addresses topics such as network adequacy, access to essential community providers, and public availability of plan information.
- March 3, 2014
Medicaid Managed Care: Financing
Read moreThis Fact Sheet addresses the following topics: choosing a health plan, consumer education, fraudulent and deceptive marketing practices, enrollment brokers, automatic assignment, and disenrollment.
- March 3, 2014
Medicaid Managed Care: Services
Read moreThis Fact Sheet addresses the following topics: choosing a health plan, consumer education, fraudulent and deceptive marketing practices, enrollment brokers, automatic assignment, and disenrollment.
- March 3, 2014
Medicaid Managed Care: Grievances and Appeals
Read moreThis Fact Sheet addresses the following topics: choosing a health plan, consumer education, fraudulent and deceptive marketing practices, enrollment brokers, automatic assignment, and disenrollment.