Medicaid & Children’s Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, & Revisions Related to Third Party Liability

The federal Centers for Medicare & Medicaid Services (CMS) released the final rule on April 25, 2016; it goes into effect by July 1, 2017. States must be in compliance with the provisions for Medicaid managed care and Children's Health Insurance Program contracts starting on or after that date. Among the provisions: CMS finalized a proposal to set medical-loss ratios (MLR) at 85%, but left many network adequacy issues to be decided by the states. CMS also finalized a proposal to end the exclusion of any payment for care provided to adults between age 21 and 64 in . . .