Information Collection

Medicaid Managed Care Regulations (States)

IC 8764 under ICR 202304-0938-003 · OMB 0938-0920.

Documents and Forms

Document Name Document Type
Form CMS-10108 Medicaid Managed Care Regulations (States) Form
Contract Portal Screenshots.docx Other-Contract Portal
Contract Portal Screenshots.docx Other-Contract Portal
CMS-10108 Managed Care Program Annual Report (MCPAR) macpar-reporting-template.pdf www.medicaid.gov/medicaid/managed-care/downloads/amcpr-reporting-template.xlsx Form
CMS-10108 Managed Care Program Annual Report (MCPAR) macpar-reporting-template.pdf www.medicaid.gov/medicaid/managed-care/downloads/amcpr-reporting-template.xlsx Form
CMS-10108 MLR Reporting Tool MLR Reporting Tool_version 12 508ed _11152021_Locked.pdf www.medicaid.gov/medicaid/managed-care/downloads/mlr-reporting-template.xlsx Form
CMS-10108 MLR Reporting Tool MLR Reporting Tool_version 12 508ed _11152021_Locked.pdf www.medicaid.gov/medicaid/managed-care/downloads/mlr-reporting-template.xlsx Form
CMS-10108 Network Adequacy and Access Assurances Tool Network Adequacy and Access Assurances Tool_508 version.pdf www.medicaid.gov/medicaid/managed-care/downloads/network-assurances-template.xlsx Form and Instruction
CMS-10108 Network Adequacy and Access Assurances Tool Network Adequacy and Access Assurances Tool_508 version.pdf www.medicaid.gov/medicaid/managed-care/downloads/network-assurances-template.xlsx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medicaid Managed Care Regulations (States)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 438.202 42 CFR 438.722 42 CFR 438.10 42 CFR 438.50 42 CFR 438.6 42 CFR 438.724 42 CFR 438.207 42 CFR 438.74 42 CFR 438.810

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10108	Managed Care Program Annual Report (MCPAR)	macpar-reporting-template.pdf	https://www.medicaid.gov/medicaid/managed-care/downloads/amcpr-reporting-template.xlsx	Yes	Yes	Fillable Fileable
Form	CMS-10108	MLR Reporting Tool	MLR Reporting Tool_version 12 508ed _11152021_Locked.pdf	https://www.medicaid.gov/medicaid/managed-care/downloads/mlr-reporting-template.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10108	Network Adequacy and Access Assurances Tool	Network Adequacy and Access Assurances Tool_508 version.pdf	https://www.medicaid.gov/medicaid/managed-care/downloads/network-assurances-template.xlsx	Yes	Yes	Fillable Fileable
Other-Contract Portal			Contract Portal Screenshots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 41	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,170,090	450	4,169,640
Annual IC Time Burden (Hours)	93,261	225	93,036
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.