Managed Care Capitation Rate Review: Total Days to Approve Rates

VISIT THE PILLAR: Federal Administrative Accountability

National Context

This measure reports the total number of days it took to review and approve states’ managed care base capitation rates and capitation rate amendments. CMS conducts actuarial reviews of these rates and amendments as part of an approval process. CMS often sends questions to states and requests additional information as part of the reviews. The total time of the review has two parts: (1) the time it takes CMS to conduct the review and (2) the time it takes states to answer questions and provide additional information.

This measure includes both parts of the review – CMS review time and states’ time to answer questions and provide additional information. The number of days for the two parts of the total review time are here: CMS Time and State Time.

The purple dash-dotted line represents the mean, or average of all values. The red dashed line represents the median, or middle of all values.

Managed Care Capitation Rate Review: Total Days to Approve Rates

This measure reports the total number of days it took to review and approve states’ managed care base capitation rates and capitation rate amendments.

Federal Administrative Accountability

Managed Care Capitation Rate Review: Total Days to Approve Rates Histogram with Median of 168, Mean of 191, and the categories and values. Described in table below.

Total Days for Rate Review	Count of Rate Certifications and Amendments
0-30	4
31-60	15
61-90	23
91-120	23
121-150	28
151-180	18
181-210	12
211-240	15
241-270	12
271-300	18
301-330	12
331-360	7
360+	16

Source: CMS Office of the Actuary (OACT)

Note: The figure includes the 203 managed care capitation rates and capitation rate amendments that were submitted to CMS in federal fiscal year 2018 and approved as of April 2019.