CMS Unable To Ensure States’ Medicaid Managed Care Rates Appropriate

Data gaps prevent the federal Centers for Medicare and Medicaid Services (CMS) from ensuring that states set appropriate Medicaid managed care rates according to the federal Government Accountability Office (GAO). CMS is responsible for overseeing the design and operations of states’ Medicaid programs; this responsibility includes ensuring that states develop rates in compliance with the managed care actuarial soundness requirements that went into effect in August 2002. The managed care actuarial soundness requirements were designed to ensure that rates are appropriate for the population and services, and are certified by actuaries. CMS regulations require states to describe the data used . . .