Unpacking the New CMS Medicaid Managed Care Rules

Sellers Dorsey Summary: CMS New MMC Rule

On April 22, CMS released the final rule, Medicaid Program; Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality (CMS-2439-F). The rule helps build stronger managed care programs to better meet the needs of the people enrolled in Medicaid and CHIP by improving access to, and quality of, care.

Didn’t have time to view the final rule? Sellers Dorsey summarized everything you need to know related to

  • Access – provider payment analysis, secret shopper surveys, wait time standards
  • State Directed Payments – submission timeframes, total payment rates, payment rate limitations, financing
  • Medical Loss Ratio Standards – provider incentives, reporting of SDPs in the MLR, level of MLR data aggregation
  • In Lieu of Services and Settings – enrollee rights and protections, medically appropriate and cost-effective, payment and rate development, state and CMS oversight
  • and more!

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Explore our in-depth report including an executive summary, key provisions, regulatory background info, and proposed and final rule language.

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Our experts created an engaging, simplified PowerPoint. Discover impacts on states, MCOs, providers, and more in under 20 slides.

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Short and simple. Explore key provisions related to access, SDPs, MLR, ILOS, Quality assessment and Quality improvement in less than 10 pages.



Sellers Dorsey experts hosted a webinar discussing the implications of the rule as well as key considerations for states, managed care plans, and others in the healthcare industry. Didn’t have a chance to attend? No problem, we recorded it.

Still have questions? Reach out to our experts at webinar@sellersdorsey.com.