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MCPAR Content Changes (#11938)
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@karla-vm
karla-vm authored Nov 25, 2024
1 parent a445753 commit f63de36
Showing 1 changed file with 14 additions and 69 deletions.
83 changes: 14 additions & 69 deletions services/app-api/forms/mcpar.json
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"validation": "radio",
"props": {
"label": "B.X.9a Website posting of 5 percent or more ownership control",
"hint": "Does the state post on its website the names of individuals and entities with 5% or more ownership or control interest in MCOs, PIHPs, PAHPs, PCCMs and PCCM entities and subcontractors? Refer to §455.104 and required by 42 CFR 438.602(g)(3).",
"hint": "Does the state posts on its website the names of individuals and entities with 5% or more ownership or control interest in MCOs, PIHPs, PAHPs, PCCMs and PCCM entities and subcontractors? Refer to 42 CFR 438.602(g)(3) and 455.104.",
"choices": [
{
"id": "fNiPtEub20Soo1W5FcdU3A",
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"section": "Section B: State-Level Indicators",
"subsection": "Topic XIII. Prior Authorization",
"spreadsheet": "B_State",
"alert": "<b>Beginning June 2026, Indicators B.XIII.1a-b–2a-b must be completed. Submission of this data before June 2026 is optional.</b>",
"info": "If the state sets timeframes for plans to respond to Prior Authorization requests that are different than timeframes specified by Federal regulation at 42 CFR §438.210(d), please respond “Yes” to the following questions."
"alert": "<b>Beginning June 2026, Indicators B.XIII.1a-b–2a-b must be completed. Submission of this data before June 2026 is optional.</b>"
}
},
"form": {
Expand All @@ -665,6 +664,7 @@
{
"id": "2nAidDjXBvvkzLtaeYyE2RymW4G",
"label": "Yes",
"hint": "If the state sets timeframes for plans to respond to Prior Authorization requests that are different than timeframes specified by Federal regulation at 42 CFR §438.210(d), please respond “Yes” to the following questions.",
"children": [
{
"id": "state_timeframesForStandardPriorAuthorizationDecisions",
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"nested": true,
"mask": "comma-separated",
"decimalPlacesToRoundTo": 2,
"parentFieldName": "state_timeframesForStandardPriorAuthorizationDecisions",
"parentFieldName": "state_stateTimeframeForStandardPriorAuthorizationDecisions",
"parentOptionId": "2nAidFCWvENhYZvzLt3DxJWOqtx"
},
"props": {
"label": "B.XIII.1b Timeframes for standard prior authorization decisions",
"label": "B.XIII.1b State’s timeframe for standard prior authorization decisions",
"hint": "Indicate the state’s maximum timeframe, as number of days, for plans to provide notice of their decisions on standard prior authorization requests."
}
}
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"parentOptionId": "2nAidJFG47lnFfJsNJS2tU7d4pp"
},
"props": {
"label": "B.XIII.2b State’s timeframe for expedited prior authorization requests",
"label": "B.XIII.2b State’s timeframe for expedited prior authorization decisions",
"hint": "Indicate the state’s maximum timeframe, as number of hours, for plans to provide notice of their decisions on expedited prior authorization requests."
}
}
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"section": "Section D: Plan-Level Indicators",
"subsection": "Topic XIII. Prior Authorization",
"spreadsheet": "D1_Plan_Set",
"alert": "<b>Beginning June 2026, Indicators D1.XIII.1-15 must be completed. Submission of this data including partial reporting on some but not all plans, before June 2026 is optional; if you choose not to response prior to June 2026, select “Not reporting data”.</b>"
"alert": "<b>Beginning June 2026, Indicators D1.XIII.1-15 must be completed. Submission of this data including partial reporting on some but not all plans, before June 2026 is optional; if you choose not to respond prior to June 2026, select “Not reporting data”.</b>"
},
"dashboardTitle": "Report on prior authorization requests received for each plan",
"drawerTitle": "Prior authorization for ",
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"drawerForm": {
"id": "dpa",
"fields": [
{
"id": "D1.XIII.1Header",
"type": "sectionHeader",
"props": {
"content": "URL where the MCO, PIHP or PAHP posts on its website prior authorization data for the prior calendar year"
}
},
{
"id": "plan_urlForPriorAuthorizationDataOnPlanWebsite",
"type": "text",
Expand All @@ -4342,14 +4335,6 @@
"hint": "Provide the URL where the plan posts prior authorization data for all items and services excluding drugs, as required in 42 CFR § 438.210(f). If you choose not to respond prior to June 2026, enter “NR” for not reporting."
}
},
{
"id": "D1.XIII.2Header",
"type": "sectionHeader",
"props": {
"divider": "top",
"content": "URL where the MCO, PIHP or PAHP posts on its website the list of all items and services, excluding drugs, subject to prior authorization"
}
},
{
"id": "plan_urlForListOfAllItemsAndServicesSubjectToPriorAuthorization",
"type": "text",
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"hint": "Provide the URL where the plan posts the list of all items and services, excluding drugs, that are subject to prior authorization, as required in 42 CFR § 438.210(f)(1). If you choose not to respond prior to June 2026, enter “NR” for not reporting."
}
},
{
"id": "D1.XIII.3Header",
"type": "sectionHeader",
"props": {
"divider": "top",
"content": "Total count of standard prior authorization requests received by the plan aggregated for all items and services, excluding drugs during the prior calendar year"
}
},
{
"id": "plan_totalStandardPriorAuthorizationRequestsReceived",
"type": "number",
Expand All @@ -4377,14 +4354,6 @@
"decimalPlacesToRoundTo": 0
}
},
{
"id": "D1.XIII.4Header",
"type": "sectionHeader",
"props": {
"divider": "top",
"content": "Total count of expedited prior authorization requests aggregated for all items and services, excluding drugs during the prior calendar year"
}
},
{
"id": "plan_totalExpeditedPriorAuthorizationRequestsReceived",
"type": "number",
Expand All @@ -4405,21 +4374,13 @@
"decimalPlacesToRoundTo": 0
}
},
{
"id": "D1.XIII.6Header",
"type": "sectionHeader",
"props": {
"divider": "top",
"content": "Standard prior authorization requests approved"
}
},
{
"id": "plan_percentageOfStandardPriorAuthorizationRequestsApproved",
"type": "number",
"validation": "number",
"props": {
"label": "D1.XIII.6 Percentage of standard prior authorization requests that were approved",
"hint": "Of the total standard prior authorization requests, as reported in D1.XIII.3, enter the percentage that were approved. If you choose not to respond prior to June 2026, enter “NR” for not reporting.",
"hint": "Of the total standard prior authorization requests, as reported in D1.XIII.3, enter the percentage that were fully approved. If you choose not to respond prior to June 2026, enter “NR” for not reporting.",
"mask": "percentage",
"decimalPlacesToRoundTo": 2
}
Expand All @@ -4430,7 +4391,7 @@
"validation": "number",
"props": {
"label": "D1.XIII.7 Percentage of standard prior authorization requests that were denied",
"hint": "Of the total standard prior authorization requests, as reported in D1.XIII.3, enter the percentage that were denied. If you choose not to respond prior to June 2026, enter “NR” for not reporting.",
"hint": "Of the total standard prior authorization requests, as reported in D1.XIII.3, enter the percentage that were fully or partially denied. If you choose not to respond prior to June 2026, enter “NR” for not reporting.",
"mask": "percentage",
"decimalPlacesToRoundTo": 2
}
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"validation": "number",
"props": {
"label": "D1.XIII.8 Percentage of standard prior authorization requests approved after appeal",
"hint": "Of the total standard prior authorization requests, as reported in D1.XIII.3, enter the percentage that were approved after appeal. If you choose not to respond prior to June 2026, enter “NR” for not reporting.",
"hint": "Of the total standard prior authorization requests, as reported in D1.XIII.3, enter the percentage that were approved after appeal. If you choose not to respond prior to June 2026, enter “NR” for not reporting.",
"mask": "percentage",
"decimalPlacesToRoundTo": 2
}
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"validation": "number",
"props": {
"label": "D1.XIII.9 Average time to decision for standard prior authorizations",
"hint": "Of the total standard prior authorization requests, as reported in D1.XIII.3, enter the average number of days that elapsed between submission of request and decision by the plan. If you choose not to respond prior to June 2026, enter “NR” for not reporting.",
"hint": "Of the total standard prior authorization requests, as reported in D1.XIII.3, enter the average number of days that elapsed between submission of request and decision by the plan. If you choose not to respond prior to June 2026, enter “NR” for not reporting.",
"decimalPlacesToRoundTo": 2
}
},
Expand All @@ -4462,18 +4423,10 @@
"validation": "number",
"props": {
"label": "D1.XIII.10 Median time to decision on standard prior authorizations",
"hint": "Of the total standard prior authorization requests, as reported in D1.XIII.3, enter the median number of days that elapsed between submission of request and decision by the plan. If you choose not to respond prior to June 2026, enter “NR” for not reporting.",
"hint": "Of the total standard prior authorization requests, as reported in D1.XIII.3, enter the median number of days that elapsed between submission of request and decision by the plan. If you choose not to respond prior to June 2026, enter “NR” for not reporting.",
"decimalPlacesToRoundTo": 2
}
},
{
"id": "D1.XIII.11Header",
"type": "sectionHeader",
"props": {
"divider": "top",
"content": "Expedited prior authorization requests aggregated for all items and services, excluding drugs"
}
},
{
"id": "plan_percentageOfExpeditedPriorAuthorizationRequestsApproved",
"type": "number",
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"validation": "number",
"props": {
"label": "D1.XIII.12 Percentage of expedited prior authorization requests that were denied",
"hint": "Of the total expedited prior authorization requests, as reported in D1.XIII.4, enter the percentage that were denied. If you choose not to respond prior to June 2026, enter “NR” for not reporting.",
"hint": "Of the total expedited prior authorization requests, as reported in D1.XIII.4, enter the percentage that were denied. If you choose not to respond prior to June 2026, enter “NR” for not reporting.",
"mask": "percentage",
"decimalPlacesToRoundTo": 2
}
Expand All @@ -4511,19 +4464,11 @@
"type": "number",
"validation": "number",
"props": {
"label": "D1.XIII.14 Median time to decision on expedited prior authorization requests",
"label": "D1.XIII.14 Median time to decision for expedited prior authorization requests",
"hint": "Of the total expedited prior authorization requests, as reported in D1.XIII.4, enter the median number of hours that elapsed between submission of request and decision by the plan. If you choose not to respond prior to June 2026, enter “NR” for not reporting.",
"decimalPlacesToRoundTo": 2
}
},
{
"id": "D1.XIII.15Header",
"type": "sectionHeader",
"props": {
"divider": "top",
"content": "Of total prior authorization requests"
}
},
{
"id": "plan_percentageOfTotalPriorAuthorizationRequestsApprovedWithExtendedTimeframe",
"type": "number",
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