CMS has released a managed care rate setting consultation guide for states to use to determine Medicaid managed care payments in calendar year 2015.
The guide specifies information CMS expects the states to provide when developing actuarial rate certifications. For example, states need to provide CMS with a letter attesting that the rates meet applicable standards from a certifying actuary who meets qualification standards established by the American Academy of Actuaries and follows Actuarial Standards Board practice standards.
This information will help ensure Medicaid managed care rates meet CMS standards. For instance, final capitation rates must be reasonable and sufficiently documented to show the rates comply with applicable laws. For more information, view the full consultation guide here.