CMS regulations at 42 CFR § 438.66(e) require states to submit a Managed Care Program Annual Report (MCPAR). Under the regulation, each state must submit to CMS, no later than 180 days after each contract year, a report on each managed care program administered by the state.
The annual report is part of CMS's overall strategy to improve access to services by supporting Federal and state access monitoring for Medicaid beneficiaries within a managed care delivery system.
The MCPAR report provides information in the following categories:
- Program enrollment and service area expansions
- Financial performance
- Encounter data reporting
- Grievances, appeals, and state fair hearings
- Availability, accessibility, and network adequacy
- Delegated entities
- Quality and performance measures
- Sanctions and corrective action plans
- Beneficiary support system (BSS)
- Program integrity
Each of the above categories have data indicators (data elements) that are organized by and will be reported at state, program, or plan levels. The blank excel workbook is available on Medicaid.gov and provides the exact indicators reported along with the instructions on how to report. Each MCPAR report for the managed care program is provided below. Based on questions received from stakeholders, the Department has prepared and posted a MCPAR Interpretation Document which provides supplemental information to help interpret the data presented in each report submission.
2023 MCPAR Submission