Market Intelligence Resource | October 21, 2015
State Guide To CMS Criteria For Managed Care Contract Review & Approval
In 2015, the Centers for Medicare and Medicaid Services (CMS) released this guide for state Medicaid programs on how to receive managed care organization (MCO) contract approval from CMS. In order to receive approval, state Medicaid programs must include the following elements in their contact; network adequacy standards; contract completeness; beneficiary enrollment and disenrollment; program integrity; quality and utilization management; and MCO policies, procedures, and systems . . .
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