Managed Care Quality Strategy | Department of Human Services | Commonwealth of Pennsylvania

Managed Care Quality Strategy | Department of Human Services | Commonwealth of Pennsylvania
Managed Care Quality Strategy, Managed Care Program Annual Report (MCPAR), and Other Federally Required Reporting
The Medicaid and CHIP Managed Care Final Rule increased state transparency requirements. States are required to provide and maintain specific content on a public website accessible to beneficiaries.  This includes the Managed Care Quality Strategy, the Annual Managed Care Program Report, Network Adequacy and Assurance Report and Managed Care Plan ownership information.
Managed Care Quality Strategy
The Centers for Medicare & Medicaid Services (CMS), per regulation 42 CFR § 438.340(a) and 42 CFR 457.1240(e), requires states to have a quality strategy for their managed care programs. The intent of the regulation is to ensure members enrolled in Medicaid managed care programs have access to high quality health care services provided by the state's managed care organizations (MCOs) or entities.
The Managed Care Quality Strategy (MCQS) for Pennsylvania's Medical Assistance (MA) and Children's Health Insurance Program (CHIP), describes the managed care programs and structures, populations served, services offered, goals and objectives, quality-related initiatives, and strategies, as well as administrative processes used to assure and monitor quality.
The draft MCQS was published for public comment in the PA Bulletin on September 23, 2023.  The summary of public comments received and the Department of Human Service's response is available
here
.
Final
Medical Assistance and Children's Health Insurance Program Managed Care Quality Strategy
- Sent to CMS December 22, 2023.
Attachments referenced in the Medical Assistance and Children’s Health Insurance Program Managed Care Quality Strategy:
External Quality Review (EQR) Reports
PH HealthChoices EQR reports
BH HealthChoices EQR reports
CHC HealthChoices EQR  reports
CHIP EQR reports
Adult Community Autism Program (ACAP) EQR reports
Link to the OMHSAS Cultural Competence Strategic Plan
Managed Care Program Annual Report (MCPAR)
CMS regulations at 42 CFR § 438.66(e) require states to submit a Managed Care Program Annual Report (MCPAR). Under the regulation, each state must submit to CMS, no later than 180 days after each contract year, a report on each managed care program administered by the state.
The annual report is part of CMS's overall strategy to improve access to services by supporting Federal and state access monitoring for Medicaid beneficiaries within a managed care delivery system.
The MCPAR report provides information in the following categories:
Program enrollment and service area expansions
Financial performance
Encounter data reporting
Grievances, appeals, and state fair hearings
Availability, accessibility, and network adequacy
Delegated entities
Quality and performance measures
Sanctions and corrective action plans
Beneficiary support system (BSS)
Program integrity
Each of the above categories have data indicators (data elements) that are organized by and will be reported at state, program, or plan levels. The blank excel workbook is available on
Medicaid.gov
and provides the exact indicators reported along with the instructions on how to report.  Each MCPAR report for the managed care program is provided below.  Based on questions received from stakeholders, the Department has prepared and posted a
MCPAR Interpretation Document
which provides supplemental information to help interpret the data presented in each report submission.
Network Adequacy and Assurance Report
States must provide documentation regarding the managed care plan's compliance with the requirements for availability and accessibility of services (including the adequacy of the provider network).
Ownership and Controlling Interest Report
States are required to report individuals within managed care organizations that have ownership or a controlling interest in the organization. The following report includes names the individuals and entities with more than 5% controlling interest.
Reporting Year 2024: The following report includes the names of individuals and entities with more than 5% controlling interest as provided by the contracting organization.
OLTL
Plan Name
Date Received
Owner Name
Owner Name
Owner Name
Owner Name
Owner Name(
AmeriHealth Caritas/Keystone First
May 2025
Vista Holdco, LLC
Blue Cross Blue Shield of Michigan Mutual Insurance Company
IBC MH, LLC
AmeriHealth, Inc.
Independence Health Group, Inc.
Pennsylvania Health & Wellness
May 2025
Centene Corporation
—
—
—
—
UPMC
May 2025
UPMC
—
—
—
—
OMAP
Plan Name
Date Received
Owner Name
Owner Name
Owner Name
Owner Name
Owner Name
Vista Health Plan, Inc.
June 2025
Vista Holdco, LLC
Blue Cross Blue Shield of Michigan Mutual Insurance Company
IBC MH, LLC
AmeriHealth, Inc.
Independence Health Group, Inc.
AmeriHealth Caritas Health Plan/Keystone Family Health Plan
June 2025
BHM Subco II, LLC
BHM Subco I, LLC
BMH LLC
Blue Cross Blue Shield of Michigan Mutual Insurance Company
IBC MH, LLC;
AmeriHealth, Inc.; Independence Health Group,
Inc.
Geisinger
May 2025
Geisinger Health Foundation
—
—
—
—
Highmark WC
May 2025
Highmark Health
—
—
—
—
HPP
May 2025
Jefferson Hospital
—
—
—
—
United
May 2025
Three Rivers Holdings, Inc.
—
—
—
—
UPMC
May 2025
UPMC
—
—
—
—
OMHSAS
Plan Name
Date Received
Owner Name
Owner Name
Owner Name
Owner Name
Owner Name
Carelon Health PA
May 2025
The Elevance Health Companies, Inc.
—
—
—
—
Community Behavioral Health
May 2025
N/A
—
—
—
—
Community Care Behavioral Health Care
May 2025
UPMC
—
—
—
—
Magellan Behavioral Health
May 2025
Centene Corporation
Magellan Health, Inc
Magellan Healthcare, Inc
Merit Behavioral Care Corporation
Magellan Behavioral Health of PA, Inc
PerformCare
May 2025
AMHP Holding Corp.
—
—
—
—
ODP
Plan Name
Date Received
Owner Name
Owner Name
Owner Name
Owner Name
Owner Name
Keystone Autism Services
May 2025
—
—
—
—
—
The following report includes the names of individuals and entities with more than 5% controlling interest as provided by the contracting organization.
OLTL
Plan Name
Date Received
Owner Name
Owner Name
Owner Name
Owner Name
Owner Name
AmeriHealth
Caritas/Keystone
First
March 2024
Vista Holdco, LLC
Blue Cross Blue Shield of Michigan Mutual Insurance Company
IBC MH, LLC
AmeriHealth, Inc.
Independence
Health Group,
Inc.
Pennsylvania Health & Wellness
March 2024
Centene Corporation
—
—
—
—
UPMC
March 2024
UPMC
NA
NA
NA
NA
OMAP
Plan Name
Date Received
Owner Name
Owner Name
Owner Name
Owner Name
Owner Name
AmeriHealth
Caritas/Keystone
First
March 2024
BHM Subco II, LLC
BHM Subco I, LLC
NA
NA
NA
Geisinger
March 2024
Geisinger Health Foundation
—
—
—
—
Highmark WC
March 2024
Highmark Health
—
—
—
—
HPP
March 2024
Jefferson Hospital
—
—
—
—
United
March 2024
Three Rivers Holdings, Inc.
—
—
—
—
UPMC
March 2024
UPMC
—
—
—
—
OMHSAS
Plan Name
Date Received
Owner Name
Owner Name
Owner Name
Owner Name
Owner Name
Carelon Health PA
March 2024
The Elevance Health Companies, Inc.
—
—
—
—
Community
Behavioral Health
March 2024
N/A
—
—
—
—
Community Care
Behavioral Health
Care
March 2024
UPMC
—
—
—
—
Magellan Behavioral Health
March 2024
Centene Corporation
Magellan Health, Inc
Magellan
Healthcare,
Inc
Merit Behavioral Care Corporation
Magellan
Behavioral
Health of PA,
Inc
PerformCare
March 2024
AMHP Holding Corp.
—
—
—
—
ODP
Plan Name
Date Received
Owner Name
Owner Name
Owner Name
Owner Name
Owner Name
Keystone Autism Services
March 2024
NA
NA
NA
NA
NA
OLTL
Plan Name
Date Received
Owner Name
Owner Name
Owner Name
Owner Name
Owner Name
AmeriHealth
Caritas/Keystone First
January 2023 for
November 2022
BHM Subco II, LLC
BHM Subco I, LLC
NA
NA
NA
Pennsylvania Health &
Wellness
January 2023 for
November 2022
BlackRock, Inc
Capital World Group
FMR LLC
Vanguard Group
T Rowe Price
Group -
UPMC
January 2023 for
November 2022
UPMC
NA
NA
NA
NA
OMAP
Plan Name
Date Received
Owner Name
Owner Name
Owner Name
Owner Name
Owner Name
AmeriHealth
Caritas/Keystone First
November
BHM Subco II, LLC
BHM Subco I, LLC
NA
NA
NA
Geisinger
November
Geisinger Health Foundation
—
—
—
—
Highmark WC
November
N/A
—
—
—
—
HPP
November
Jefferson Hospital
—
—
—
—
United
November
Three Rivers Holdings, Inc.
—
—
—
—
UPMC
November
UPMC
—
—
—
—
OMHSAS
Plan Name
Date Received
Owner Name
Owner Name
Owner Name
Owner Name
Owner Name
Beacon Health Options
December
N/A
—
—
—
—
Community Behavioral
Health
December
N/A
—
—
—
—
Community Care
Behavioral Health
December
N/A
—
—
—
—
Magellan Behavioral
Health
December
N/A
—
—
—
—
PerformCare
December
N/A
—
—
—
—
ODP
Plan Name
Date Received
Owner Name
Owner Name
Owner Name
Owner Name
Owner Name
Keystone Autism
Services
December
Keystone Human Services
NA
NA
NA
NA
The Pennsylvania Department of Human Services (DHS or Department) MA and CHIP programs are administered through the following main programs:
Physical Health HealthChoices (PH HC)
, which provides PH (medical care) services through physical health managed care organizations (PH-MCOs).
2024 MCPAR for the PH HC Program
2024 MCPAR Interpretation Document
Past Reports:
2023 MCPAR for the PH HC Program
2023 MCPAR Interpretation Document
2022 MCPAR for the PH HC Program
2022 MCPAR Interpretation Document
2025 Network Adequacy and Assurance Report and Supporting Documentation
Community HealthChoices (CHC)
, which provides PH services along with long-term services and supports (LTSS) through CHC-MCOs for adults who require LTSS, as well as adults eligible for both Medicaid and Medicare (Dual Eligible).
2024 MCPAR for the CHC Program
2024 MCPAR Interpretation Document
Past Reports:
2023 MCPAR for the CHC Program
2023 MCPAR Interpretation Document
2022 MCPAR for the CHC Program
2022 MCPAR Interpretation Document
2023 Network Adequacy and Assurance Report and Supporting Documentation
Behavioral Health HealthChoices (BH HC)
, which is a BH carve-out that provides mental health and substance use disorder (SUD) services through county-based entities that subcontract with BH-MCOs for both PH HC and Community HealthChoices (CHC) members.
2024 MCPAR for the BH HC Program
2024 MCPAR Interpretation Document
Past Reports:
2023 MCPAR for the BH HC Program
2023 MCPAR Interpretation Document
2022 MCPAR for the BH HC Program
2022 MCPAR Interpretation Document
2023 Network Adequacy and Assurance Report and Supporting Documentation
Adult Community Autism Program (ACAP)
, which is a fully integrated program that provides PH, BH and home- and community-based services (HCBS) to adults with an autism spectrum disorder (ASD).
2024-2025 MCPAR for the ACAP Program
Past Reports:
2023-2024 MCPAR for the ACAP Program
2022-2023 MCPAR for the ACAP Program
2021 -2022 MCPAR for the ACAP Program
submitted 12/31/2022.
CHIP
, which is operated as a standalone program, covering PH and BH services for children with incomes above the MA income thresholds.
DHS uses this page to provide public access to the MCQS and its supporting materials.