Medicaid Managed Care Quality including Supporting Regulations in §§438.310, 438.330, 438.332, 438.334, and 438.340 (CMS-10553)

Section 1932(c)(1) requires states to develop and implement quality assessment and improvement strategies for their managed care arrangements. Section 1902(a)(4) requires such methods of administration as are found by the Secretary to be necessary for the proper and efficient operation of the plan. Section 1902(a)(6) requires that the State agency will make such reports (e.g. state quality strategy effectiveness evaluation), in such form and containing such information, as the Secretary may from time to time require, and comply with such provisions as the Secretary may from time to time find necessary to assure the correctness and verification of such reports. Section 1902(a)(19) requires safeguards as may be necessary to assure that eligibility for care and services under the plan will be determined, and such care and services will be provided, in a manner consistent with simplicity of administration and the best interests of the recipients.

The latest form for Medicaid Managed Care Quality including Supporting Regulations in §§438.310, 438.330, 438.332, 438.334, and 438.340 (CMS-10553) expires 2027-09-30 and can be found here.

State Governments

Federal Enterprise Architecture: Health - Health Care Services