This summary report details an evaluation of the Quality Strategy for Healthy Louisiana, Louisiana’s Medicaid managed care (MMC) program.
Authorizing legislation and regulation for state Medicaid managed care programs include the Social Security Act (Part 1915i and Part 1932(a)),ii the Balanced Budget Act of 1997 (BBA)iii and Title 42, Part 438 of the Code of Federal Regulations (CFR).iv On May 6, 2016, the Centers for Medicare and Medicaid Services (CMS) published the Medicaid and Children’s Health Insurance Program (CHIP) programs; Medicaid Managed Care, CHIP Delivered in Managed Care and Revisions Related to Third Party Liability Final Rule in the Federal Register.v The Final Rule modernized Medicaid managed care regulations to reflect changes in the usage of managed care delivery systems and sought to align Medicaid rules with those of other health insurance coverage programs, modernize how states purchase managed care for beneficiaries, and strengthen consumer experience and consumer protections.