Given the large and growing role that managed care plays in Medicaid (now accounting for nearly half of program spending), one significant area of interest has been the mechanisms the federal government uses to hold states accountable, and states use to hold managed care organizations accountable for the services they provide to enrollees.
This presentation reviews key elements of managed care oversight. It covers the key elements of managed care oversight, including payment, network adequacy, quality measurement, and reporting, and concludes with an update on the status of yet-to-be-implemented provisions of the 2016 final managed care rule and the Centers for Medicare & Medicaid Services’ review of that regulation.