Section IV: Federal and Professional Guidance
This section includes guidance from the Centers for Medicare & Medicaid Services (CMS) and Actuaries Standards Board to help states in developing actuarially sound rates for MLTSS programs.
2016 Medicaid Managed Care Rate Development Guide (September 2015, Centers for Medicare & Medicaid Services) This guide describes the information that states and their actuaries should provide when developing actuarial rate certifications so that CMS can determine whether the data, assumptions, and methodologies are consistent with generally accepted actuarial practices, and whether the capitation rates are appropriate for the populations and services to be covered.
Guidance to States Using 1115 Demonstrations or 1915(b) Waivers for Managed Long Term Services and Supports Programs (May 2013, Centers for Medicare & Medicaid Services) This report shares best practices for implementing MLTSS programs and clarifies CMS’ expectations of states using Section 1115 demonstrations or 1915(b) waivers combined with another authority in an MLTSS program. An accompanying summary describes 10 elements that CMS expects states to incorporate into MLTSS programs.
Medicaid Managed Care Capitation Rate Development and Certification (March 2015, Actuarial Standards Board) This document provides guidance for actuaries preparing, reviewing, or giving advice on capitation rates for Medicaid programs.