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 …
Medicaid and CHIP Managed Care Quality
Many states deliver services to Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries via managed care arrangements.
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 …
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 …
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 …
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 …
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 …
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 …