Appropriate payment and access to quality care in Medicaid managed care programs and preventing fraud, waste, and abuse is a responsibility of both the federal government and the states. Section F of MACPAC’s June 2011 report examines state and federal administration and oversight of Medicaid managed care programs and highlights program integrity requirements at the state and federal level to ensure proper payment for appropriate, high quality care in both fee for service and managed care.
This section also discusses data that support policy development and program accountability and some of the challenges and limitations in current data collection for Medicaid managed care. It provides information on the key federal authorities allowing Medicaid managed care, as well as comprehensive risk-based contract requirements. Read more about program accountability, integrity and data in Medicaid managed care.
From: June 2011 Report to Congress: The Evolution of Managed Care in Medicaid