martes, 1 de agosto de 2017

CIB: Medicaid and CHIP Managed Medical Loss Ratio (MLR) Credibility Adjustments and New Toolkit for Promoting Access in Medicaid and CHIP Managed Care: Strategies for Ensuring Provider Network Adequacy and Service Availability

Today, the Centers for Medicare & Medicaid Services (CMS) issued an Informational Bulletin providing the required MLR credibility adjustments for Medicaid and CHIP managed care plans with rating periods beginning July 1, 2017 or later.  This bulletin also contains OACT’s methodology for developing the credibility adjustments as required in the final rule and examples of how states should apply the MLR credibility adjustments.  In alignment with MLR requirements for health plans operating in the private market and Medicare Advantage, the Medicaid and CHIP managed care rule provides a credibility adjustment to account for the potential variation in smaller managed care plans.  The credibility adjustment is used to account for random statistical variation related to the number of enrollees in a managed care plan. CMS will publish MLR credibility adjustment factors on an annual basis.

The informational bulletin can be accessed on at

CMS also released a toolkit to assist states in developing their network adequacy and service availability standards for Medicaid and CHIP managed care.  To develop this toolkit, CMS formed a working group of states to discuss common access challenges and goals, as well as to create a forum for states to present their successful techniques for establishing and monitoring network adequacy in their programs.  The product of this group’s efforts is a compilation of effective and promising network adequacy and service availability strategies and analysis techniques, as well as valuable data sources that states are using to develop and assess the availability of providers and services in their states.

The toolkit can be accessed on at

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