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 …
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 …
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 …
Jul 1, 2011 · Managed Care in Puerto Rico This profile reflects state managed care program information as of August 2021, and only includes information on active federal operating …
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 …
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 …
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 …
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 …
Medicaid and CHIP Managed Care Reporting
The May 2016 Medicaid and CHIP managed care final rule strengthened the federal oversight of state managed care programs in several ways, one of which was to create new reporting …
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 …