Book Description
State and CMS oversight of the Medicaid managed care credentialing process.
Author : CreateSpace Independent Publishing Platform
Publisher : Createspace Independent Publishing Platform
Page : 28 pages
File Size : 10,26 MB
Release : 2018-07-05
Category :
ISBN : 9781722299149
State and CMS oversight of the Medicaid managed care credentialing process.
Author : United States. Department of Health and Human Services. Office of Inspector General
Publisher :
Page : 23 pages
File Size : 10,65 MB
Release : 2013
Category : Group medical practice
ISBN :
Author : United States. Department of Health and Human Services. Office of Inspector General
Publisher :
Page : 23 pages
File Size : 50,18 MB
Release : 2013
Category : Group medical practice
ISBN :
Author : United States. Social and Rehabilitation Service
Publisher :
Page : 460 pages
File Size : 10,67 MB
Release : 1975
Category : Medicaid
ISBN :
Author : United States. General Accounting Office
Publisher :
Page : 44 pages
File Size : 27,66 MB
Release : 1995
Category : Managed care plans (Medical care)
ISBN :
Author : United States. Government Accountability Office
Publisher :
Page : 34 pages
File Size : 22,3 MB
Release : 2010
Category : Managed care plans (Medical care)
ISBN :
Medicaid managed care rates are required to be actuarially sound. A state is required to submit its rate-setting methodology, including a description of the data used, to the Department of Health and Human Services' (HHS) Centers for Medicare & Medicaid Services (CMS) for approval. The Children's Health Insurance Program Reauthorization Act of 2009 required GAO to examine the extent to which states' rates are actuarially sound. GAO assessed CMS oversight of states' compliance with the actuarial soundness requirements and efforts to ensure the quality of data used to set rates. GAO reviewed documents, including rate-setting review files, from 6 of CMS's 10 regional offices. The selected offices oversaw 26 of the 34 states with comprehensive managed care programs; the states' programs varied in size and accounted for over 85 percent of managed care enrollment. GAO interviewed CMS officials and Medicaid officials from 11 states that were chosen based in part on variation in program size and geography. GAO recommends that CMS implement a mechanism to track state compliance with the requirements, clarify guidance on rate-setting reviews, and make use of information on data quality in overseeing states' rate setting.
Author : United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Oversight and Investigations
Publisher :
Page : 160 pages
File Size : 34,22 MB
Release : 1993
Category : Medical
ISBN :
Author : U.s. Government Accountability Office
Publisher : Createspace Independent Publishing Platform
Page : 40 pages
File Size : 10,38 MB
Release : 2017-08-11
Category :
ISBN : 9781974446742
Medicaid managed care rates are required to be actuarially sound. A state is required to submit its rate-setting methodology, including a description of the data used, to the Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) for approval. The Childrens Health Insurance Program Reauthorization Act of 2009 required GAO to examine the extent to which states rates are actuarially sound. GAO assessed CMS oversight of states compliance with the actuarial soundness requirements and efforts to ensure the quality of data used to set rates. GAO reviewed documents, including rate-setting review files, from 6 of CMSs 10 regional offices. The selected offices oversaw 26 of the 34 states with comprehensive managed care programs; the states programs varied in size and accounted for over 85 percent of managed care enrollment. GAO interviewed CMS officials and Medicaid officials from 11 states that were chosen based in part on variation in program size and geography.
Author :
Publisher :
Page : 546 pages
File Size : 24,2 MB
Release : 2017-11-27
Category :
ISBN : 9781683086857
In addition to reprinting the PDF of the CMS CoPs and Interpretive Guidelines, we include key Survey and Certification memos that CMS has issued to announced changes to the emergency preparedness final rule, fire and smoke door annual testing requirements, survey team composition and investigation of complaints, infection control screenings, and legionella risk reduction.
Author : United States Government Accountability Office
Publisher :
Page : 40 pages
File Size : 42,62 MB
Release : 2018-01-11
Category :
ISBN : 9781983739347
Medicaid Managed Care: CMS's Oversight of States' Rate Setting Needs Improvement