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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.