Latest From Andy
Standards for Provider Network Adequacy in Medicaid and the Marketplaces
The Centers for Medicare & Medicaid Services (CMS) has issued final rules for provider network adequacy in Qualified Health Plans (QHPs) offering coverage in the Marketplaces that the federal government operates through HealthCare.gov. Under these rules, which come with the snappy title, “Notice of Benefit and Payment Parameters” and the even snappier initialism (NBPP), CMS […]
Medicaid Managed Care: The Big Five in PHE Q9 (Q1 2022)
March 31 marked the end of the ninth quarter of the COVID-19 Public Health Emergency (PHE). First declared by the Secretary of HHS on January 31, 2020, the PHE has subsequently been extended nine times, through July 15. As long as the PHE is in place, states qualify for an additional 6.2 percentage points on […]
Medicaid Managed Care Compliance Tools: Another ‘Pay-For’
Discussions have begun on the possibility of enacting a scaled-down version of the Build Back Better legislation. Any agreement that includes new federal spending will also require pay-fors (a/k/a offsets) either in the form of spending reductions or tax increases, or both. In Medicaid, responsible pay-fors—i.e., policy changes that the Congressional Budget Office will score […]
Medicaid Managed Care: SDOH, MCO, and MLR
There is no shortage of acronyms or initialisms in government agencies and programs and Medicaid is no exception. The Medicaid and CHIP Payment and Access Commission or MACPAC (one of our favorite acronyms) devotes an entire glossary to them. The most prominent initialism in Medicaid policy discussions these days is SDOH: social determinants of health, […]
Medicaid Managed Care: What Can the Annual MLR Report Tell Us?
Over 32.8 million children are covered by Medicaid, and the large majority are enrolled by their state Medicaid agencies in managed care organizations (MCOs). In exchange for monthly capitation payments, the MCOs contract with the state Medicaid agency to furnish covered services through networks of providers. These arrangements, in 40 states and the District of […]