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 …
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 …
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 …
Medicaid and CHIP Managed Care Quality
Many states deliver services to Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries via managed care arrangements.
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 package Payment is risk …
Because Medicaid beneficiaries may be concurrently enrolled in more than one type of managed care program (e.g., a Comprehensive MCO and a BHO), users should not sum enrollment …
Quality of Care External Quality Review | Medicaid
An External Quality Review (EQR) is the analysis and evaluation by an external quality review organization (EQRO) of aggregated information on quality, timeliness, and access to the …
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 …
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 …