Information Collection

Medicaid Managed Care: States

IC 261963 under ICR 202308-0938-018 · OMB 0938-1453.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1453 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10108 Medicaid Managed Care: States	Form
Contract Portal Screenshots.docx	Other-Contract Portal Screenshot
Contract Portal Screenshots.docx	Other-Contract Portal Screenshot
CMS-10108 Managed Care Program Annual Report (MCPAR) Template The Managed Care Program Annual Report (MCPAR Template.pdf	Form
CMS-10108 Managed Care Program Annual Report (MCPAR) Template The Managed Care Program Annual Report (MCPAR Template.pdf	Form
CMS-10108 Medical Loss Ratio (MLR) Reporting Template Medical Loss Ratio (MLR) Reporting Template.pdf	Form
CMS-10108 Medical Loss Ratio (MLR) Reporting Template Medical Loss Ratio (MLR) Reporting Template.pdf	Form
CMS-10108 Network Adequacy and Access Assurances Tool Access and Network Adequacy Assurances Reporting Tool.pdf	Form
CMS-10108 Network Adequacy and Access Assurances Tool Access and Network Adequacy Assurances Reporting Tool.pdf	Form

IC Title:

Medicaid Managed Care: States

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10108	Managed Care Program Annual Report (MCPAR) Template	The Managed Care Program Annual Report (MCPAR Template.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10108	Medical Loss Ratio (MLR) Reporting Template	Medical Loss Ratio (MLR) Reporting Template.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10108	Network Adequacy and Access Assurances Tool	Access and Network Adequacy Assurances Reporting Tool.pdf	Yes	Yes	Fillable Fileable
Other-Contract Portal Screenshot			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: 49

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	9,909	9,909
Annual IC Time Burden (Hours)	94,929	94,929
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.