CMS LTSS Matrix Portion

For Informational Purposes Only

Comparison of Existing Managed Care Plan Requirements and Preferred Requirement Standards for Financial Alignment Demonstration Plans Related to Network Adequacy

The chart below adapts information from the May 16, 2011 Federal Register Notice, Vol. 76, No. 94, which outlined, among other items, key differences between Medicaid and Medicare managed care administration requirements. This chart also describes pre-established parameters articulated in the July 8, 2011 Medicaid Director Letter, as well as MMCO’s position on preferred requirements for States and plans participating in the capitated model, and authority needed to carry out this preferred position.

1 For Informational Purposes Only Federal Medicaid Medicare Requirements Pre-Established Parameter and/or Preferred A State-Specific Negotiated Requirements Requirement Standard u Standard t (To be jointly completed) h o r i t y

N e e d e d

I m p l e m e n t

R e q u i r e m e n t Medicaid managed Medicare Advantage requires that Preferred Requirement Standard: Use State M 2 For Informational Purposes Only