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What is the current status of Medicaid Managed Care (MMC)? Summer/Fall 2012

Posted: September 6, 2013

The US federal agency which administers Medicare and Medicaid or the Centers for Medicare & Medicaid Services (CMS) is reviewing or will be reviewing the following items:

State Plan Amendment (SPA)

Capitated rates paid to the Managed care Organizations (MCO’s)

MMC Contract between the state of NH and the MCO’s

· All three of the above items must be approved by CMS.

The MCO’s are attempting to contract with NH medical and behavioral health providers to create an “adequate” healthcare network. Each MCO network must be approved by DHHS and CMS.

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