CMS issues updated guide to Medicaid managed care contract review

The Centers for Medicare & Medicaid Services yesterday released updated guidance for states submitting Medicaid managed care contracts for review. The guide incorporates changes included in the 2020 Medicaid and Children’s Health Insurance Program managed care final rule pertaining to pass-through payments, state-directed payments, network adequacy standards, risk sharing mechanisms, appeals and grievances, and requirements for beneficiary information. It also covers standards used to review and approve state Medicaid contracts with prepaid inpatient and ambulatory health plans, primary care case management entities and health insuring organizations.