Reporting Requirements Submission Schedule: Quality Management/ Utilization Management

The State of Pennsylvania Department of Public Welfare (DPW) operates HealthChoices mandatory managed care in 25 counties for people eligible for Temporary Assistance for Needy Families (TANF) or Supplemental Security Income (SSI). As of October 7, 2006, total HealthChoices enrollment was about one million people. Voluntary Medicaid managed care is available in 27 counties. In the 42 counties where HealthChoices is not available, the state offers Access Plus, an enhanced primary care case management program for people eligible for TANF or SSI. To ensure high quality care, the state set up a reporting structure for information sharing between managed care organizations and DPW. The report schedule sets staggered due dates so that some reports are due monthly, some quarterly, and some on an annual basis. The following documents are lists of the report titles in three broad categories: financial, operations, and quality and utilization management and the reporting frequency of each report.