2016 Medicaid Managed Care Rate Development Guide

The Centers for Medicare & Medicaid Services (CMS) has released the final 2016 Medicaid Managed Care Rate Development Guide for states to use in development of any Medicaid managed care rates with rating periods starting on or after January 1, 2016.  This follows the release of the draft Guide in June of 2015 where CMS collected public input.  Although the final Guide has remained largely the same from its draft version, this Guide includes revisions based on the input collected which includes but is not limited to 1) changes around the administrative load development, 2) clarity on defining the types of managed care plans, 3) when a legally mandated change should be incorporated into the rates, and 4) clarification on the types of supporting documentation expected.  States and their actuaries should follow this guide in development of their actuarial certifications in order to streamline the review process. CMS will use this Guide as well as the regulations found at 42 CFR 438.6 as the basis for the review of 2016 actuarial certifications. 

The Guide is available online on the Guidance tab under the Technical Assistance accordion athttp://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/managed-care/managed-care-site.html.  Please direct any questions about this Guide toMMCratesetting@cms.hhs.gov.