Three years ago, the Center for Medicaid & CHIP Services (CMCS) issued an CMCS Informational Bulletin (CIB) on “Medicaid and CHIP Managed Care Monitoring and Oversight Tools.” The CIB triggered a 2016 regulatory requirement that states contracting with managed care organizations (MCOs) submit to CMCS a Managed Care Program Annual Report (MCPAR). The MCPAR contains information about the performance of each MCO during the most recent contract year. Its purpose is to “allow CMS…to target efforts to assist states in improving their managed care programs while also ensuring compliance with managed care statutes and regulations, such as ensuring access to care.”
Although it was not obvious at the time, this June 2021 CIB was to be the first of what has turned out to be an annual series of CIBs on this topic (as well as others). A brief history of MCPARs in the first three CIBs is here. The fourth just dropped earlier this month. (CMCS also issued a bonus pack of FAQs in March). Here are its three take-aways on MCPARs. First, they’re still a work in progress. Second, CMCS continues to expect state Medicaid agencies to post them so the public can learn about how individual MCOs are performing. Finally, CMCS will also begin posting MCPARs on a regular basis on Medicaid.gov. Hooray! When? “In the next year.” Let’s take these one at a time.
The data elements that MCPAR collects from states are contained in a reporting template. This month’s CIB explains that, since December 2022, when the first MCPAR reports were due, CMS has updated the MCPAR template several times to ensure it is functioning correctly and “to revise questions to ensure the report collected useful information.” Noting the 2023 Office of the Inspector General (OIG) report on high denial rates as well as the February 2024 final regulation on prior authorization timeframes, the CIB indicates that the MCPAR will be further updated to include fields to collect MCO-specific data related to prior authorization. In addition, CMCS is updating the MCPAR to include fields related to mental health and substance use disorder parity requirements in order to “facilitate State reporting of plan performance.”
There’s a large audience for information about the performance of individual MCOs collected by the MCPARs, including state and federal policymakers, consumer advocates, health services researchers, and the press. The trick has been accessing the reports. A December 2023 scan of state Medicaid agency websites found that only five managed care states (Arkansas, Louisiana, Mississippi, Ohio, and Pennsylvania) posted their MCPARs as required by federal regulation. (Interestingly, over the past six months, an additional 13 state Medicaid agencies also posted their MCPARs: Georgia, Hawaii, Indiana, Iowa, Michigan, Missouri, Nebraska, Nevada, New Hampshire, New Mexico, Tennessee, Utah, Washington). Still, more than half of the 41 managed care states do not post.
In May of this year CMS issued a final Managed Care Rule reaffirming this transparency requirement. In the CIB, CMCS “reminds” state Medicaid agencies that “they must post MCPARs on the State’s website” and provide the MCPAR to their Medicaid Advisory Committees. The CIB further explains that CMCS is “undertaking efforts to improve transparency by publicly posting MCPARs in the next year on a regular basis on Medicaid.gov.”
Currently, the CMCS website advises that “MCPAR reports submitted to CMS in 2022 and 2023 are available upon request.” That’s not good enough. The MCPARs for the calendar 2023 contract year are due this week (June 28). Stipulating that CMCS is understaffed, why should it take another year to post the reports the states submit?
That said, CMCS has committed to post the MCPARs. Doing so on “a regular basis” will mark a major, if long overdue, transparency upgrade for CMCS, one that creates an opportunity for the public to access performance information on individual MCOs in every managed care state—whether or not their state posts. As such, it has the potential to open a new chapter in the saga of transparency and accountability for MCOs and state Medicaid agencies alike.
