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Accounting for Access in Managed Care Rate Setting and Actuarial Soundness

The Centers for Medicare & Medicaid Services has indicated that it will release proposed regulations addressing access, including access in managed care settings, in 2023.

This session continued the Commission’s work on Medicaid managed care rate setting by facilitating a discussion on how access is considered in federal guidance, actuarial soundness standards, and the rate setting process. During the September 2022 meeting, staff reviewed potential policy areas that the Commission could discuss that would serve as the basis for comments when proposed regulations are released.

This presentation provided an overview of our prior findings specific to the treatment of access in rate setting and raised potential areas for the Commission’s consideration that could be addressed in a future comment letter.