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CMS Issues FAQ on Medicaid Managed Care Final Rule

The Centers for Medicare & Medicaid Services (CMS) on Nov. 10 released a new frequently asked questions (FAQ) document on the Medicaid and Children’s Health Insurance Program (CHIP) managed care final rule.

The final rule, which was released in May, was the first update to Medicaid and CHIP managed care regulations in more than a decade. With the rule, CMS sought to better align the regulations with existing standards for commercial, health insurance marketplace, and Medicare Advantage plans.

The FAQ provides clarification on requirements for managed care contracts, defining and implementing a rating period, and state expenditure reporting and claiming instructions for external quality reviews (EQRs), among other things. The FAQ also notes that CMS expects to publish revised protocols for current EQR-related activities in fall 2017.

For specific questions related to EQRs, contact the CMS Division of Quality and Health Outcomes at

If you have questions or concerns, please contact Director of Policy Erin O’Malley at or 202.585.0127.



About the Author

Michelle Rosenfeld is manager of communications at America's Essential Hospitals.

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