MEDICAID MANAGED CARE
Enrollment Statistics
Children's Hospice
Solicitation - June 8, 2000
Descriptions of State
Programs
Programs for All Inclusive Care for the Elderly (PACE)
Final Rules
Rate Setting for Risk-Based Contracts
- Federal Regulatory
Requirements [42 CFR 438.6(c)] (PDF 21KB)
-
- These are the regulations implementing section 1903(m)(2)(A)(iii) of the
Social Security Act requiring payments in risk contracts to be made on an
actuarially sound basis.
- Checklist—Financial
Documentation for At-Risk Capitated Contracts Rate Setting
(7/22/03) (PDF 432KB)
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- This is a tool used by CMS Regional Offices in their review and approval of
rates in risk-based Medicaid managed care contracts.
- Draft Health Practice Note 2004-1,
Actuarial Certification of Rates for Medicaid Managed Care
Programs, by the American Academy of Actuaries Medicaid Rate
Certification Work Group --
www.actuary.org/pdf/practnotes/health_medicaid_july04.pdf
This link will connect you to the draft Practice Note that was developed by an
work group of actuaries who are familiar with rate setting issues in Medicaid
managed care programs from various perspectives. It is intended to provide
guidance to actuaries in certifying rates and rate ranges in risk contracts. As
a draft document, this Practice Note is subject to change.
- A Guide for Implementing
a Health-Based Risk-Adjusted Payment System for Medicaid Managed Care
Programs (ZIP 2.5MB) --A Guide for States – There are a
total of 35 files, totaling over 2,460 KB. The pages are in a variety of
formats including Power Point, Microsoft Word and Excel. Please be advised that
individual files can be very large and may take considerable time to download
or to print.
- Financial
Attachment (PDF 105KB)
-
- This site contains "A Guide to Implementing a Health-Based
Risk-Adjusted Payment System for Medicaid Managed Care Programs." This
guide was developed by the Center for Health Program Development and Management
at the University of Maryland, Baltimore County, and the Actuarial Research
Corporation under contract with the Centers for Medicare and Medicaid Services
(CMS). CMS is making this information available as a general resource on
health-based risk adjustment and examples of how such payment systems can be
implemented by State Medicaid agencies.
However. CMS neither requires health-based risk adjustment, nor endorses any
particular method or model of health-based risk adjustment in Medicaid managed
care payment systems.
Quality
Special Needs Populations
Technical Assistance and
Guidance
Waivers and Demonstrations
CMS Guidelines on Key
Approaches to the Use of Managed Care Systems for Persons With Special Health
Care Needs.
Public Affairs
Note: Some of the files on this page are available only in Adobe Acrobat - Portable Document Format (PDF). To view PDF files, you must have the Adobe Acrobat Reader (minimum version 5, version 6 suggested). You can check here to see if you have the Acrobat Reader installed on your computer. If you do not already have the Acrobat Reader installed, please go to Adobe's Acrobat download page now.
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Last Modified on Thursday, September 16, 2004
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