Managed Care | Medicaid
Managed Care is a health care delivery system organized to manage cost, utilization, and quality. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services …
Drug Utilization Review Annual Report | Medicaid
May 29, 2025 · On an annual basis, states are required to report on their practitioners prescribing habits, cost savings generated from their Drug Utilization Review (DUR) programs and their program’s …
Managed Care Entities | Medicaid
Federal Managed Care regulations at 42 CFR 438 recognize four types of managed care entities:Managed Care Organizations (MCOs)Comprehensive benefit packagePayment is risk …
January 18, 2022 This guide covers the standards that are used by the Centers for Medicare & Medicaid Services (CMS) Division of Managed Care Operations (DMCO) staff to review and approve State …
Pennsylvania began experimenting with various managed care arrangements in the 1970’s, beginning with the introduction of its Voluntary Managed Care Program, a comprehensive risk-based MCO …
Introduction The Centers for Medicare & Medicaid Services (CMS) is releasing the 2025-2026 Medicaid Managed Care Rate Development Guide for use in setting rates for rating periods starting between …
State Drug Utilization Review Reporting | Medicaid
Aug 18, 2025 · In 2019, CMS released the FFS and Managed Care Organization (MCO) Surveys for FFY 2018 and at that time, CMS introduced the Medicaid Drug Programs (MDP) system, a more …
Medicaid and CHIP Managed Care Reporting
CMS has also created a web-based reporting portal for these reports, thereby creating a single submission process and repository for all state reporting requirements related to managed care. The …
a way that the MCO, PIHP, or PAHP would reasonably achieve a medical loss ratio standard greater than 85 percent, as calculated under 42 CFR § 438.8, as long as the capitation rates are adequate …
Enrollment Report | Medicaid
The Medicaid Managed Care Enrollment Report provides plan-specific enrollment statistics on Medicaid managed care programs. The managed care enrollment report includes statistics, in point-in-time …