The federal government published new Medicaid managed care regulations on May 6, 2016. The new regulations are extensive, and will affect every aspect of Medicaid coverage provided through managed care. The new regulations will be phased in over time from 2016 through 2019.
Justice in Aging has developed this chart to assist advocates in using and analyzing the new regulations. With this tool, you can search for regulations by section number, section title, the key issue the provision addresses, and effective date. The chart also provides a summary and background on each provision and offers advocacy tips where applicable.
Note: This chart includes all of the managed care regulations that are effective on or before July 5, 2016. By mid-July 2016, the chart will be revised to include all of the managed care regulations, regardless of effective date.
Rating Periods: Many provisions are effective based on rating periods. Rating periods are the twelve month period for which capitation rates are developed under a managed care contract.
Plan(s): We employ the term “plan” as an umbrella term to include all managed care entities subject to the regulations including Managed Care Organizations (MCOs), Prepaid Inpatient Ambulatory Health Plans (PIHPs), Prepaid Ambulatory Health Plans (PAHPs), and Primary Care Case Management (PCCMs). If a provision applies to a certain type of managed care entity, we specify this in the summary and background.