May 29, 2015

On June 1, 2015, the Centers for Medicare and Medicaid Services (CMS) will publish in the Federal Register a long-awaited proposed rule addressing Medicaid Managed Care Organizations (MMCOs). Comments on the proposed rule will be accepted through July 27, 2015. For MMCOs and their participating providers, this is the first major CMS guidance since 2002. The proposed rule would impose significant changes for both MMCOs and their network providers, including:

  • Implementation of Medical Loss Ratio Requirements
  • Overpayment Retention and Reporting
  • MMCO Compliance
  • Affirmation of Third Party Liability Rules
  • New Provider Enrollment Requirements

For more information regarding the proposed rule revisions, please click here.