Medicaid Managed Care Policies & Reports

Managed Care Program Annual Reports (MCPAR)

The Centers for Medicare and Medicaid Services (CMS) developed a web-based reporting portal for the collection of each state’s managed care information. States submit reports to CMS 180 days after the end of their state fiscal year.  In New Hampshire, the MCM Contract year ends June 30, and the MCPAR is submitted by December 30 each year.  

Content of the Report
As defined by the regulation, the report will collect information in the following categories:
1. Program enrollment and service area expansions
2. Financial performance
3. Encounter data reporting
4. Grievances, appeals, and state fair hearings
5. Availability, accessibility, and network adequacy
6. Delegated entities
7. Quality and performance measures
8. Sanctions and corrective action plans
9. Beneficiary support system (BSS)
10. Program integrity
 

New Hampshire submitted reports:

• SFY2023 NH MCPAR
• SFY2022 NH MCPAR
• CMS State Submitted MCPARs

Medical Loss Ratio (MLR) Reports 

In an effort to ensure transparency and protect Medicaid from paying excessive health plan administrative expenses or profits, CMS requires reporting of each Medicaid health plan's medical loss ratio (MLR). MLR reports monitor costs and revenues and help to ensure that a sufficient percentage of the total per enrollee capitation paid to the health plan is spent on health care services or quality improvement.  You can find further details on Medicaid health plans' MLRs on the CMS website.  The CMS MLR Summary page includes plan-specific MLRs and data on states that recovered revenue from plans that did not achieve a target MLR percentage.