CMS has opportunities to strengthen states’ oversight of Medicaid Managed Care Plans’ reporting of medical loss ratios

CMS has opportunities to strengthen states’ oversight of Medicaid Managed Care Plans’ reporting of medical loss ratios

Collection:
Health Policy and Services Research
Series Title(s):
Report in brief (United States. Department of Health and Human Services. Office of Inspector General)
Contributor(s):
United States. Department of Health and Human Services. Office of Inspector General. Office of Evaluation and Inspections, issuing body.
Publication:
Washington, D.C. : U.S. Department of Health and Human Services, Office of Inspector General, September 2022
Language(s):
English
Format:
Text
Subject(s):
Government Regulation
Managed Care Programs -- organization & administration
Medicaid
State Health Planning and Development Agencies
United States
Centers for Medicare & Medicaid Services (U.S.)
Genre(s):
Technical Report
Abstract:
Why OIG Did This Review. State and Federal expenditures on Medicaid managed care are growing and totaled $360 billion in 2020, which was 55 percent of total Medicaid expenditures in that year. With its 2016 Medicaid managed care regulations, the Centers for Medicare & Medicaid Services (CMS) chose medical loss ratios (MLRs) as a policy tool to apply across the program to ensure appropriate stewardship of managed care funds. States’ oversight of their plans’ annual MLR reporting is critical to improve fiscal transparency, monitor costs, and promote high-quality care in Medicaid managed care. How OIG Did This Review. We administered an online survey to and requested information from all States with Medicaid managed care plans subject to Federal MLR requirements as of September 1, 2020. Between September 2020 and December 2020, 43 States submitted survey responses and plans’ annual MLR reports. We reviewed and summarized States’ survey responses and analyzed plans’ MLR reports for completeness.
Copyright:
The National Library of Medicine believes this item to be in the public domain. (More information)
Extent:
1 online resource (1 PDF file (35 pages))
Illustrations:
Illustrations
NLM Unique ID:
9918715886006676 (See catalog record)
Permanent Link:
http://resource.nlm.nih.gov/9918715886006676