Actuarial Study Could Affect Medicaid Managed-Care Rates

Published Online: May 28, 2014
The CMS has unveiled two initiatives that could significantly affect pay and operations for Medicaid managed-care plans and healthcare providers serving millions of low-income and disabled Americans.

The agency has launched a study of the adequacy of how the states set payment rates to plans, which in turn affects the adequacy of reimbursements to providers, said Camille Dobson, a senior policy adviser at the CMS, at the Institute for International Research's Medicaid Managed Care Congress in Baltimore on May 21.

The analysis involves Medicaid policy staff teaming with the CMS' Office of the Actuary to determine if payments are actuarially sound. It will look at whether the payments cover all anticipated medical costs, administrative costs, taxes and fees a plan will be responsible for, but also to ensure that health plans are not overpaid.

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Source: Modern Healthcare