Sec. 4001. Promoting value in Medicaid managed care
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/bill/115/hr/6/eah/section-4001A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 1903(m) of the Social Security Act ( 42 U.S.C. 1396b(m) ), as amended by sections 1013 and 1016, is further amended by adding at the end the following new paragraph: With respect to expenditures described in subparagraph
(B)that are incurred by a State for any fiscal year after fiscal year 2020 (and before fiscal year 2024), in determining the pro rata share to which the United States is equitably entitled under subsection (d)(3), the Secretary shall substitute the Federal medical assistance percentage that applies for such fiscal year to the State under section 1905(b) (without regard to any adjustments to such percentage applicable under such section or any other provision of law) for the percentage that applies to such expenditures under section 1905(y). Expenditures described in this subparagraph, with respect to a fiscal year to which subparagraph
(A)applies, are expenditures incurred by a State for payment for medical assistance provided to individuals described in subclause
(VIII)of section 1902(a)(10)(A)(i) by a managed care entity, or other specified entity (as defined in subparagraph (D)(iii)), that are treated as remittances because the State— has satisfied the requirement of section 438.8 of title 42, Code of Federal Regulations (or any successor regulation), by electing— in the case of a State described in subparagraph (C), to apply a minimum medical loss ratio (as defined in subparagraph (D)(ii)) that is at least 85 percent but not greater than the minimum medical loss ratio (as so defined) that such State applied as of May 31, 2018; or in the case of a State not described in subparagraph (C), to apply a minimum medical loss ratio that is equal to 85 percent; and recovered all or a portion of the expenditures as a result of the entity’s failure to meet such ratio. For purposes of subparagraph (B), a State described in this subparagraph is a State that as of May 31, 2018, applied a minimum medical loss ratio (as calculated under subsection
(d)of section 438.8 of title 42, Code of Federal Regulations (as in effect on June 1, 2018)) for payment for services provided by entities described in such subparagraph under the State plan under this title (or a waiver of the plan) that is equal to or greater than 85 percent. For purposes of this paragraph: The term managed care entity means a medicaid managed care organization described in section 1932(a)(1)(B)(i). The term minimum medical loss ratio means, with respect to a State, a minimum medical loss ratio (as calculated under subsection
(d)of section 438.8 of title 42, Code of Federal Regulations (as in effect on June 1, 2018)) for payment for services provided by entities described in subparagraph
(B)under the State plan under this title (or a waiver of the plan). The term other specified entity means— a prepaid inpatient health plan, as defined in section 438.2 of title 42, Code of Federal Regulations (or any successor regulation); and a prepaid ambulatory health plan, as defined in such section (or any successor regulation). .
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Sec. 4001
Promoting value in Medicaid managed care
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