Managed Care Archive

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  • Issue Brief 7: Medicaid Managed Care Final Regulations: BSS

    Senior Attorney Elizabeth Edwards provides analysis and guidance on the updated rule regarding managed care plans in Medicaid, and how it relates to new requirements around beneficiary support systems (BSS). Edwards explains that the updated rule, adopted this year by the U.S. Department of of Health and Human Services…

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  • Issue Brief: A Primer on Reference Pricing & VBID

    Cost sharing is too often a tool that prevents low-income individuals from being able to access quality and timely health care services. Health care experts, however, are exploring other mechanisms, such as Value-Based Insurance Design (VBID) and its Reference Pricing ways to address shortcomings of cost sharing. VBID, at…

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  • NHeLP Comments to PERM Regulations

    Leo Cuello

    In comments to the U.S. Department of Health and Human Services, NHeLP Director of Health Policy Leonardo Cuello recommends that HHS should make the Payment Error Rate Measurement regulations consistent with the recently released Medicaid managed care regulations and use the Payment Error Rate Measurement process as a tool to promote…

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  • NHeLP Comments to MACRA Regulations

    Leo Cuello

    In comments to the U.S. Department of Health and Human Services, NHeLP Director of Health Policy Leonardo Cuello recommends that HHS should improve the Medicare and CHIP Reauthorization Act regulations to encourage models of care that will provide consumers with high-quality care, and put less emphasis only on increasing provider risk…

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  • Issue Brief 6: Medicaid Managed Care Final Regulations: Older Adults

    Leo Cuello

    In this issue brief, Leonardo Cuello reviews the recently finalized Medicaid managed care regulations, and how they impact access to health care for older adults. He highlights important new provisions in the regulations on a range of topics such as enrollment protections, network adequacy requirements, long-term services and supports…

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  • Issue Brief: Why Are Medicaid Lock-in Programs Used and How Can They Be Improved

    In this Issue Brief, Legal Director Jane Perkins explains what Medicaid lock-in programs are, what are the legal requirements for implementing them, and how these programs can be improved to better serve Medicaid beneficiaries.

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