Today, the Centers
for Medicare & Medicaid Services (CMS) issued a Medicaid Informational Bulletin that provides
guidance to states on the implementation and compliance requirements of the
Medical Loss Ratio (MLR) that should be included in their Medicaid managed
care contracts. States are required to include requirements for
managed care plans to calculate and report an MLR.
These requirements
were established under the 2016 Medicaid managed care regulations for
contracts that started on or after July 1, 2017. Additionally, the
Substance Use-Disorder Prevention that Promotes Opioid Recovery and
Treatment for Patients and Communities Act (SUPPORT Act) added statutory
requirements to encourage the use of remittances if a managed care plan
does not meet a minimum MLR of at least 85 percent.
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