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 …
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 …
CHIP Managed Care | Medicaid
In July 2018, we developed a guide covering the standards that are used by the Centers for Medicare & Medicaid Services (CMS) staff to review state contracts with CHIP managed care organizations …
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 …
Managed Care in Arizona This profile reflects state managed care program information as of August 2014, and only includes information on active federal operating authorities, and as such, the program …
In 2011, the state further expanded managed care through its Healthy Connections Choices program when it began enrolling additional Medicaid beneficiaries formerly served in the FFS system in either …
The Maryland MCO MLR Reporting Instructions companion guide provides additional guidance to its MCPs on MLR reporting and the components of the MLR calculation.
Medicaid and CHIP Managed Care Quality
Many states deliver services to Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries via managed care arrangements. Federal regulations at 42 CFR 438 for Medicaid, and incorporated …
Coordination of Benefits & Third Party Liability | Medicaid
Coordination of Benefits Coordination of Benefits (COB) refers to the activities involved in determining Medicaid benefits when an enrollee has coverage through an individual, entity, insurance, or …