DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid 
Services 7500 Security Boulevard 
Mail Stop S2-26-12  
Baltimore, Maryland  21244-1850 
CMCS Informational Bulletin 
 
DATE:  July 6, 2022 
 
FROM:    Daniel Tsai, Deputy Administrator and Director 
 
SUBJECT:    Medicaid and CHIP Managed Care Monitoring and Oversight Tools 
 
 
The purpose of this Center for Medicaid and CHIP Services (CMCS) Informational Bulletin 
(CIB) is to provide additional tools for states and the Centers for Medicare & Medicaid Services 
(CMS) to improve the monitoring and oversight of managed care in Medicaid and the Childrens 
Health Insurance Program (CHIP). 
 
Introduction 
 
In a CIB dated June 28, 2021, CMS recognized the need to develop tools to help states improve 
their monitoring and oversight of Medicaid and CHIP managed care programs.  The June 2021 
CIB also released a reporting template for the Managed Care Program Annual Report, 
announced the development of a web-based reporting portal for the collection of all required 
managed care reports, and released two technical assistance toolkits for state use.  CMS also 
committed to developing additional tools for monitoring and oversight of managed care.   
 
Today, CMS is providing an update on the web-based reporting portal. We are also releasing two 
additional reporting templates, related to Medical Loss Ratio (MLR) and network adequacy and 
access assurances; a new technical assistance toolkit for states to oversee access in Managed 
Long-Term Services and Supports (MLTSS) programs; and initial recommended practices and 
strategies for ensuring timely and accurate payment to Indian health care providers. 
 
Web-Based Reporting Portal for the Collection of Required Managed Care Reports 
 
In June 2021, CMS announced its intention to develop a web-based reporting portal, creating a 
single submission process and repository for all state reporting requirements related to managed 
care.  These reports include: the Managed Care Program Annual Report required in 42 CFR  
438.66(e), the Medical Loss Ratio (MLR) Summary Report required in 42 CFR  438.74(a), and 
the Network Adequacy and Access Assurances Report required in 42 CFR  438.207(d). 
 
The web-based portal will be built within the Medicaid Data Collection Tool (MDCT) currently 
used by CMS to collect, and states to submit, several required Medicaid and CHIP reports 
including CARTS, SEDS, and QMR.  A separate module titled MDCT-Managed Care 
Reporting will be built to house the managed care reports. 
 
MDCT-Managed Care Reporting will consist of fillable forms to be filled out by States based on 
the data they collected using the indicators contained in the Excel template.  The structured data  Page 2  CMCS Informational Bulletin 
 
captured by this system will allow CMS to generate and analyze state-specific and nationwide 
data across the universe of managed care programs and requirements.  This data analysis will 
allow CMS to identify areas for technical assistance and 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. 
 
Information about MDCT-Managed Care Reporting is available at 
https://www.medicaid.gov/medicaid/managed-care/guidance/medicaid-and-chip-managed-care-
reporting/index.html.  Currently, the website contains basic information about each report and its 
deadlines, along with links to download the Excel template version of each report.  It also 
contains a link to MDCT-Managed Care Reporting that will only be available to state staff with 
access to this web-based portal.  CMCS staff will be reaching out to states directly to make sure 
that appropriate state staff are granted access.  This will start in the very near future so that each 
state has access when the web-based forms are ready for use.   
 
As the web-based forms are developed, CMS will announce their availability to states.  At those 
times, states will be able to enter their information directly into the fillable forms, creating 
efficiency for states and CMS.  The fillable forms will collect exactly the same information that 
is included in the Excel templates for each report.  CMS anticipates that the Managed Care 
Program Annual Report will be available first, in early November 2022.  Please note, CMS 
acknowledges that it is delayed in making this web-based portal available; however, the 
reporting deadlines communicated in the prior guidance will remain in effect because states are 
able to access the report templates now on Medicaid.gov.  This gives states the ability to start 
compiling the information to be prepared for their first report.  CMS believes this is particularly 
important for states whose first report is due no later than December 27, 2022. 
 
Reporting and New Templates 
 
Medical Loss Ratio (MLR) Reporting Template 
 
CMS regulations at 42 CFR  438.74(a) require that states annually submit, with their rate 
certification required in 42 CFR  438.7, a summary description of the MLR report(s) received 
from the managed care organization (MCOs), prepaid inpatient health plans (PIHPs), and prepaid 
ambulatory health plans (PAHPs) under contract with the state.  CMS has developed a standard 
format, with instructions, for this required MLR Report.  An Excel version of the report is 
available on Medicaid.gov at https://www.medicaid.gov/medicaid/managed-
care/guidance/medicaid-and-chip-managed-care-reporting/index.html.  During the development 
of this report template, CMS consulted with states and other stakeholders on the content and 
form of the report.  The final report template includes changes made to address comments and 
concerns from those entities. 
 
The requirement for states to submit this information to CMS began for rating periods starting on 
or after July 1, 2017.  However, to date, there has been no requirement to use a standard 
reporting template.  The Excel template is available for states to use immediately if they choose.  
However, all states submitting rate certification packages on or after October 1, 2022 are 
required to use the template.  Further, it should be submitted as additional documentation when 
 
  Page 3  CMCS Informational Bulletin 
 
the annual rate certification is submitted.  Once the web-based forms are available in MDCT-
Managed Care Reporting, states will be required to submit the report through the electronic  
portal.  The web-based forms will collect exactly the same information that is included in the 
Excel workbook, and CMS will update states when they are available. 
 
CMS encourages states to review the template to ensure they understand the required fields and 
instructions.  If states would like to request technical assistance related to the report, contact the 
CMCS managed care state lead for your respective State or complete the Medicaid Managed 
Care  State Technical Assistance Request Form. 
 
Network Adequacy and Access Assurances Report 
 
CMS regulations at 42 CFR  438.207(d) require that states: 
  Submit an assurance of compliance to CMS that the each MCO, PIHP, and PAHP meets 
the states requirement for availability of services; and 
  Include documentation of an analysis that supports the assurance of the adequacy of the 
network for each contracted MCO, PIHP, or PAHP related to its provider network. 
 
These regulations require states to submit this information: 
  At the time the state enters into a contract with each MCO, PIHP, or PAHP; 
  On an annual basis; and 
  Any time there is a significant change in the operations that would affect the adequacy of 
capacity and services of an MCO, PIHP, or PAHP. 
  Note: CMS recommends that the report be submitted at the same time a state submits the 
associated managed care contract to CMS for approval, including a new contract, a 
renewal, or an amendment. 
 
CMS has developed a standard format, with instructions, for this required Network Adequacy 
and Access Assurances Report.  An Excel version of the report is available on Medicaid.gov at 
https://www.medicaid.gov/medicaid/managed-care/guidance/medicaid-and-chip-managed-care-
reporting/index.html.  During the development of this report template, CMS consulted with 
states and other stakeholders on the content and form of the report.  The final report template 
includes changes made to address comments and concerns from those entities. 
 
The requirement for states to submit this information to CMS began with all contracts with rating 
periods beginning on or after July 1, 2018.  However, to date, there has been no requirement to 
use a standard reporting template.  The Excel template is now available for states to use 
immediately if they choose.  All states submitting the report on or after October 1, 2022 are 
required to use the template.  Once the web-based forms are available in MDCT-Managed Care 
Reporting, states will be required to submit the report through the electronic portal.  The web-
based forms will collect exactly the same information that is included in the Excel workbook, 
and CMS will update states when they are available. 
 
CMS encourages states to review the template on Medicaid.gov to ensure they understand the 
required fields and instructions.  If states would like to request technical assistance related to the  
 
 
  Page 4  CMCS Informational Bulletin 
 
report, contact your CMCS managed care state lead or complete the Medicaid Managed Care  
State Technical Assistance Request Form. 
 
Transparency Requirements Relative to the Network Adequacy and Access Assurances Report  
 
CMS regulations at 42 CFR  438.68(e) require states to publish their network adequacy 
standards developed pursuant to 42 CFR  438.66(b) on their state operated website.  
Additionally, 42 CFR  438.602(g)(2) requires states to post documentation described in 42 CFR 
 438.207(b) on which it based its assurance of compliance of availability and accessibility of 
services as required in 42 CFR  438.207(d).  CMS expects the information that states publish 
pursuant to these requirements to include the Network Adequacy and Access Assurances Report 
for each program that it operates.  
 
Reminder: Managed Care Program Annual Report 
 
In the CIB dated June 28, 2021, CMS provided guidance on the Managed Care Program Annual 
Report, including information on the timing, content, and form of the report, and a standard 
reporting template available at https://www.medicaid.gov/medicaid/managed-
care/guidance/medicaid-and-chip-managed-care-reporting/index.html.  Note: The Excel version 
of the template has been updated slightly.  The updates are cosmetic in nature to improve ease of 
use and align more closely to the format of the web-based form in MDCT-Managed Care 
Reporting.  Both versions and the web form will collect exactly the same information.  States can 
use the Excel template to begin collecting the information needed for the web form. 
 
Because the requirement to submit the annual report was triggered by the June 2021 CIB, and the 
due dates are dependent upon the Contract Year of each managed care program, CMS is taking 
this opportunity to remind states of the upcoming due dates for the first round of reports. 
 
Contract Year of the  Contract Period of First  First Report 
Managed Care Program  Report 
July through June  7/1/2021  6/30/2022  December 27, 2022 
September through August  9/1/2021  8/31/2022  February 27, 2023 
October through September  10/1/2021  9/30/2022  March 29, 2023 
January through December  1/1/2022  12/31/2022  June 29, 2023 
February through January  2/1/2022  1/31/2023  July 30, 2023 
April through March  4/1/2022  3/31/2023  September 27, 2023 
 
The report will be collected electronically through MDCT-Managed Care Reporting.  
Information about MDCT-Managed Care Reporting is available at 
https://www.medicaid.gov/medicaid/managed-care/guidance/medicaid-and-chip-managed-care-
reporting/index.html.  Currently, the website contains basic information about the report and its 
deadlines, along with a link to download the Excel template version of the report.  It also 
contains a link to MDCT-Managed Care Reporting that will only be available to state staff with 
access to this web-based portal.  CMCS staff will be reaching out to states directly to make sure 
that appropriate state staff are granted access.  This will start in the very near future so that each 
state has access when the web-based forms are ready for use.  When the web-based form is 
 
  Page 5  CMCS Informational Bulletin 
 
ready, CMS will announce its availability to states.  CMS anticipates that the web-based 
submission form for the Managed Care Program Annual Report will be available in early 
November 2022. 
 
Public Availability of Reports 
 
CMS will make all reports submitted through MDCT-Managed Care Reporting available after 
CMS has completed an initial review of the reports.  Once a Medicaid.gov page is established for 
the reports, CMS will announce its availability.  Until that time, reports will be made available 
upon request. 
 
Promoting Access in Medicaid and CHIP Managed Care: Managed Long-Term Services 
and Supports Access Monitoring Toolkit 
 
In the June 2021 CIB, CMS committed to developing a series of technical assistance toolkits to 
assist states in complying with various managed care standards and regulations, and to help 
improve state monitoring and oversight of their managed care programs.  Today, CMS is 
releasing a toolkit entitled, Promoting Access in Medicaid and CHIP Managed Care: Managed 
Long-Term Services and Supports Access Monitoring Toolkit. 
 
This toolkit is intended as a resource for state Medicaid and CHIP agency staff who are 
developing or implementing monitoring practices to oversee access in Managed Long-Term 
Services and Supports (MLTSS) programs.  It highlights effective or promising practices 
currently used in states as examples.  The toolkit was developed in response to the growth in 
MLTSS programs in recent years and concerns raised by federal oversight agencies about access 
to services and quality of care for individuals enrolled in MLTSS programs.  Chapter I describes 
federal regulations issued from 2016 and 2020 and previous guidance from 2013 that establish 
access monitoring requirements for states operating MLTSS programs.  Chapter I also highlights 
the importance of care quality, in particular the health and welfare of MLTSS enrollees.  
However, methods to assure quality of care broadly are outside the scope of this toolkit.  The 
toolkit includes two additional Chapters: Chapter II describes key data sources and strategies for 
monitoring MLTSS access, and Chapter III provides examples of how to apply these strategies to 
monitor access to MLTSS.  The toolkit is available on Medicaid.gov at 
www.medicaid.gov/medicaid/managed-care/guidance/medicaid-and-chip-managed-care-
monitoring-and-oversight-initiative/index.html.  
 
Ensuring Timely and Accurate Payment to Indian Health Care Providers 
 
In a 2016 final rule,1 CMS codified a range of Indian managed care protections at 42 C.F.R.  
438.14 and 457.1209 that allow Indians enrolled in Medicaid and CHIP managed care plans to 
continue to receive services from an Indian Health Care Provider (IHCP), even if the IHCP does 
not participate in the plans network, and ensures IHCPs are appropriately paid for services 
provided.  The 2016 final rule also addressed other Tribal issues, such as sufficient network and 
payment requirements for managed care plans that serve Indians, network provider agreements 
                                                      
1 The final 2016 rule is available at https://www.federalregister.gov/articles/2016/05/06/2016- 
09581/medicaid-and-childrens-health-insurance-program-chip-programs-medicaid-managedcare-chip-delivered.   
 
  Page 6  CMCS Informational Bulletin 
 
with IHCPs, state-Tribal consultation requirements, and referrals and prior authorization 
requirements.  In December 2016, CMS issued a CIB to summarize the Indian managed care 
protections set forth in the regulations.2 
 
To assist states in complying with the Indian managed care protections, CMS has been working 
with states, Tribes, IHCPs, and managed care plans to identify and resolve implementation and 
compliance issues on a state-by-state basis.  To address the issues from a national perspective, 
CMS also collaborated with the National Indian Health Board (NIHB) to convene a Managed 
Care Listening Session of Tribal leaders and, in May 2021, NIHB convened a Roundtable of 
Tribal health directors and Medicaid staff to discuss strategies and identify recommended 
practices and resources to aid all states and managed care plans in implementing the statutory 
and regulatory Medicaid managed care protections for Indians. The recommended practices and 
strategies include: 
 
(1) States should engage with Tribes through effective Tribal consultation to identify and 
resolve issues; 
(2) Medicaid and CHIP managed care plans should use the Indian contract addendum to 
negotiate contracts between plans and IHCPs (see Appendix A of the 2016 CIB);  
(3) States and managed care plans should institutionalize knowledge of the Indian health 
care delivery system and Indian managed care protections;  
(4) States and managed care plans should have a single state point of contact to handle 
Medicaid managed care issues for IHCPs;  
(5) Medicaid managed care plans should develop internal claims processing practices 
specific to IHCPs to resolve claims in a timely manner; and  
(6) For state Medicaid agencies, including a managed care contract provision requiring 
managed care plans pay IHCPs the full Indian Health Service All-Inclusive Rate, 
rather than the plan paying at the plans regular provider payment rate and requiring 
IHCPs to bill the state for a wrap-around payment.3 (This would also be a best 
practice for managed care plans to employ, even if not directed by the state Medicaid 
agency to do so).  
 
NIHB will be posting a full report of the findings from the Roundtable and CMS will alert states 
when it is available.  CMS also will be providing additional guidance to assist states and 
managed care plans regarding implementing the statutory and regulatory Medicaid managed care 
protections for Indians, including a toolkit that will describe in more detail the practices and 
strategies identified through the NIHB Roundtable. 
                                                      
2 December 14, 2016 CIB, Indian Provisions in the Final Medicaid and Childrens Health Insurance Program 
Managed Care Regulations. available at  https://www.medicaid.gov/federal-policy-
guidance/downloads/cib121416). 
 
 
3 On an annual basis, the Indian Health Service calculates and publishes in the Federal Register calendar year 
inpatient and outpatient Medicare and Medicaid reimbursement rates, referred to as the All-Inclusive Rates. The 
rate is applicable to reimbursement methodologies under the Medicare and Medicaid programs.  See 2022 IHS 
reimbursement rates: https://www.federalregister.gov/documents/2022/04/08/2022-07468/reimbursement-rates-for-
calendar-year-2022 
 
 
  Page 7  CMCS Informational Bulletin 
 
Closing  
 
CMS is committed to strengthening the monitoring and oversight of Medicaid and CHIP 
managed care programs.  CMS looks forward to continuing to collaborate with states on the 
implementation of these tools and anticipates issuing additional tools periodically to improve its 
monitoring and oversight activities in Medicaid and CHIP managed care.  If you have any 
questions or need additional information, please contact John Giles, Director, Division of 
Managed Care Policy at 410-786-5545 or John.Giles1@cms.hhs.gov.