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 …
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 …
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 …
South Carolina Managed Care Program Features, as of 2021 (1 of 2)
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 …
New York Managed Care Program Features, as of 2021 (1 of 2)
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 requirements for …
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 approve State …
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 health care …