Reimbursement

reimbursement hub home

New Medicaid Managed Care Rules

1
Select your area of interest
2
Contact details

We are always interested in engaging with you.

Let us know how we can help.

1
2
Contact details

Submit a sales inquiry

Please provide some information below and we can help direct you to the right person
We work with partners and distributors who may contact you about this Philips product on our behalf.
*
*
*
*
*
*
*
*

Philips values and respects the personal information of its customers. You may revoke the permissions you grant at any time. See the Philips Privacy Policy for more information.
Les informations collectées sont enregistrées par Philips France Commercial, 33 rue de Verdun 92150 Suresnes. Vos données seront conservées en dehors de l’Union Européenne et utilisées par les services marketing de Philips pour une durée de 24 mois à compter de leur collecte ou du dernier contact de votre part. Conformément à la loi n°78-17 Informatique et Libertés modifiée et au Règlement européen n° 2016/679 vous bénéficiez, sur les données personnelles qui vous concernent, d’un droit d’accès et de rectification et, s'ils sont applicables, d'un droit de suppression, d’opposition, d'effacement, de limitation du traitement, et de portabilité. Vous pouvez exercer ces droits en vous adressant à : privacy@philips.com en fournissant un justificatif d'identité. Vous pouvez également définir des directives relatives au sort de vos données après votre décès et introduire une réclamation auprès de la CNIL. 

April 29, 2016

 

For the first time in more than a decade, the Centers for Medicare & Medicaid Services (CMS) has issued regulations that update how Medicaid works for the nearly two-thirds of beneficiaries who get coverage through private managed care plans. The final regulations modernize the way managed care plans operate and address issues ranging from electronic communications and delivery reforms to the adequacy of provider networks and medical loss ratios:

 

Highlights:
 

  • CMS establishes the medical loss ratio (MLR) at 85% for managed care plans operating in Medicaid, thus aligning with the requirements of the Affordable Care. The medical loss ratio refers to the percentage of premium revenues that insurance plans must spend on medical care, versus administrative or marketing activities.
  • CMS directs states to set the adequacy standards for networks of hospitals and physicians serving Medicaid patients. This focuses largely on the maximum time and distance patients must travel to reach the nearest provider.
  • CMS encourages states to take steps to foster delivery system reforms—such as medical homes, value-based purchasing, improved coordination among providers, and quality and performance targets for providers and health plans.

 

When the regulations were first proposed, Philips urged CMS to ensure that Medicaid managed care plans meet the needs of patients with multiple chronic conditions. View summary of Philips comments