Information Collection

Medicaid Managed Care Regulations (States)

IC 8764 under ICR 202601-0938-007 · OMB 0938-0920.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10108 Managed Care Program Annual Report (MCPAR) Medicaid Managed Care Regulations (States)	Form
Form CMS-10108 Managed Care Program Annual Report (MCPAR) Medicaid Managed Care Regulations (States)	Form
Form CMS-10108 MLR Reporting Tool Medicaid Managed Care Regulations (States)	Form
Form CMS-10108 MLR Reporting Tool Medicaid Managed Care Regulations (States)	Form
Form CMS-10108 Network Adequacy and Access Assurances Tool Medicaid Managed Care Regulations (States)	Form and Instruction
Form CMS-10108 Network Adequacy and Access Assurances Tool Medicaid Managed Care Regulations (States)	Form and Instruction
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 438.810 42 CFR 438.724 42 CFR 438.10 42 CFR 438.50 42 CFR 438.6 42 CFR 438.207 42 CFR 438.74

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10108	https://www.medicaid.gov/medicaid/managed-care/downloads/amcpr-reporting-template.xlsx	Yes	Yes	Fillable Fileable
Form	CMS-10108	https://www.medicaid.gov/medicaid/managed-care/downloads/mlr-reporting-template.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10108	https://www.medicaid.gov/medicaid/managed-care/downloads/network-assurances-template.xlsx	Yes	Yes	Fillable Fileable
Other-Contract Portal			Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,034,367	864,277	4,170,090
Annual IC Time Burden (Hours)	124,408	31,147	93,261
Annual IC Cost Burden (Dollars)	0	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.

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