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October 27, 2016

CMS Releases 2017 Medicaid Managed Care Rate Development Guide, but New Provider Payment Provisions Remain to be Addressed

Oct. 27, 2016: CMS has issued its Medicaid Managed Care Rate Development Guide for rating periods starting between January 1, 2017 and June 30, 2017.  A number of critical provisions from the new regulations, including provisions related to special contract provisions for provider payments, are not effective until rating periods after July 1, 2017, and will not be reflected until the next update to the guide (for rating periods starting July 1, 2017 through June 30, 2018). The guide describes CMS’ process that it expects states and their actuaries to undertake in setting managed care rates, including their treatment of so-called “pass-through payments,” and how to incorporate amounts paid under fee-for-service for supplemental provider payments into the managed care capitation rates. Look for updates to this guide prior to July 1, 2017 for more information about how CMS will review states’ implementation of new managed care requirements impacting “directed expenditures” and “pass-through” supplemental payments.