Rate Review and Rate Guides | Medicaid

Rate Review and Rate Guides | Medicaid

Today, the Centers for Medicare & Medicaid Services (CMS) released the 2020-2021 Medicaid Managed Care Rate Development Guide for use by states in setting their capitation rates between July 1, 2020 and June 30, 2021 for managed care programs subject to the actuarial soundness requirements.

This guide includes information that states must include in their rate certifications to ensure that CMS can determine compliance with the applicable provisions in federal statute. A new addition to this year’s rate guide is the national roll-out of an accelerated rate review process. A new appendix to the rate guide summarizes the accelerated rate review process, participation criteria, and documentation requirements. In particular, states that elect to use the accelerated rate review process must submit a Rate Development Summary identifying key elements.

• 2020-2021 Medicaid Managed Care Rate Development Guide