Medical Loss Ratio (MLR) Monitoring, Reporting, and Oversight: A Toolkit for States to Ensure Complete and Accurate MLR Reporting
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Associated Project
Supporting CMS and State Use of Medicaid Managed Care Payment Strategies
Prepared for:
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services
This toolkit provides practical information to support states’ review, validation, and oversight of their Medicaid managed care plans' annual MLR reporting. States can use the guidance, suggested approaches, and tools provided in this toolkit to improve the completeness and accuracy of managed care plan-reported MLR data in five areas: (1) MLR data collection, (2) MLR data validation, (3) using validated MLR information for state financial monitoring and oversight, (4) reporting guidance for high impact areas such as non-claims costs and expense allocation methodologies, and (5) creating an effective oversight system within the state Medicaid agency.
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