# Medicaid plan appeals, State Fair Hearings, grievances and prior authorization by plan (CMS MCPAR, PY2023-2024)

`medicare_semantic.vw_medicaid_mcpar_plan_appeals_v1` · State programs · status live · 1,380 rows

Plan-level appeals (resolved, active, by outcome, reason and service, timeliness), State Fair Hearings, external medical review, grievances (resolved, active, by service and reason, timeliness) and prior-authorization metrics from the CMS Medicaid Managed Care Program Annual Report public use file, sections D1.IV and D1.XIII, pivoted from medicare_silver.medicaid_mcpar_puf_v1, with medicaid_plan_id, plan_display_name, program_class and parent_name from the plan crosswalk where it resolves (391 of 704 PY2023 rows, 374 of 676 PY2024). Values are the publisher's numbers; NULL means the response was not a number (N/A, NR) or the question was not on the form version the state filed, and indicators_* count which.

**Grain.** One row per performance_year x state x program x reporting period x plan name as the state printed it (plan_name_raw); 704 PY2023 + 676 PY2024 = 1,380 rows, grain unique (verifier view_grain_unique, Athena 2273b054; rows Athena 21a8eb55).

| column | type | meaning |
|---|---|---|
| performance_year | int |  |
| state_code | string |  |
| state_name | string |  |
| program_name_raw | string |  |
| reporting_period_start | date |  |
| reporting_period_end | date |  |
| plan_name_raw | string |  |
| medicaid_plan_id | string |  |
| plan_region | string |  |
| plan_display_name | string |  |
| program_class | string |  |
| parent_name | string |  |
| plan_id_match_method | string |  |
| appeals_resolved | double |  |
| appeals_denied_adverse | double |  |
| appeals_resolved_partially_favorable | double |  |
| appeals_resolved_favorable | double |  |
| appeals_active | double |  |
| appeals_filed_ltss_users | double |  |
| critical_incidents_ltss_after_appeal | double |  |
| appeals_standard_resolved_timely | double |  |
| appeals_expedited_resolved_timely | double |  |
| appeals_reason_authorization_denied_or_limited | double |  |
| appeals_reason_reduction_suspension_termination | double |  |
| appeals_reason_payment_denial | double |  |
| appeals_reason_service_timeliness | double |  |
| appeals_reason_plan_untimely_response | double |  |
| appeals_reason_out_of_network_denial | double |  |
| appeals_reason_financial_liability_dispute | double |  |
| appeals_service_inpatient_general | double |  |
| appeals_service_outpatient_general | double |  |
| appeals_service_inpatient_behavioral_health | double |  |
| appeals_service_outpatient_behavioral_health | double |  |
| appeals_service_outpatient_prescription_drug | double |  |
| appeals_service_snf | double |  |
| appeals_service_ltss | double |  |
| appeals_service_dental | double |  |
| appeals_service_nemt | double |  |
| appeals_service_dme_supplies | double |  |
| appeals_service_home_health | double |  |
| appeals_service_emergency | double |  |
| appeals_service_therapies | double |  |
| appeals_service_other | double |  |
| fair_hearing_requests | double |  |
| fair_hearing_favorable | double |  |
| fair_hearing_adverse | double |  |
| fair_hearing_retracted | double |  |
| external_review_favorable | double |  |
| external_review_adverse | double |  |
| grievances_resolved | double |  |
| grievances_active | double |  |
| grievances_filed_ltss_users | double |  |
| critical_incidents_ltss_after_grievance | double |  |
| grievances_resolved_timely | double |  |
| grievances_service_inpatient_general | double |  |
| grievances_service_outpatient_general | double |  |
| grievances_service_inpatient_behavioral_health | double |  |
| grievances_service_outpatient_behavioral_health | double |  |
| grievances_service_outpatient_prescription_drug | double |  |
| grievances_service_snf | double |  |
| grievances_service_ltss | double |  |
| grievances_service_dental | double |  |
| grievances_service_nemt | double |  |
| grievances_service_dme | double |  |
| grievances_service_home_health | double |  |
| grievances_service_emergency | double |  |
| grievances_service_therapy | double |  |
| grievances_service_other | double |  |
| grievances_reason_customer_service | double |  |
| grievances_reason_care_case_management | double |  |
| grievances_reason_access_to_care | double |  |
| grievances_reason_quality_of_care | double |  |
| grievances_reason_plan_communication | double |  |
| grievances_reason_payment_billing | double |  |
| grievances_reason_suspected_fraud | double |  |
| grievances_reason_abuse_neglect_exploitation | double |  |
| grievances_reason_untimely_response | double |  |
| grievances_reason_denial_of_expedited_appeal | double |  |
| grievances_reason_other | double |  |
| pa_standard_requests | double |  |
| pa_expedited_requests | double |  |
| pa_total_requests | double |  |
| pa_standard_pct_approved | double |  |
| pa_standard_pct_denied | double |  |
| pa_standard_pct_approved_after_appeal | double |  |
| pa_standard_avg_days | double |  |
| pa_standard_median_days | double |  |
| pa_expedited_pct_approved | double |  |
| pa_expedited_pct_denied | double |  |
| pa_expedited_avg_hours | double |  |
| pa_expedited_median_hours | double |  |
| pa_pct_approved_extended_timeframe | double |  |
| pa_data_url | string |  |
| pa_items_list_url | string |  |
| indicators_number | bigint |  |
| indicators_not_applicable | bigint |  |
| indicators_optional_not_reported | bigint |  |
| indicators_not_reported | bigint |  |
| indicators_without_a_line | bigint |  |
| source_url | string |  |
| sha256_content_hash | string |  |

Query it: `query_substrate` with `SELECT ... FROM medicare_semantic.vw_medicaid_mcpar_plan_appeals_v1 WHERE ... LIMIT 100`; read `describe_data_source("medicare_semantic.vw_medicaid_mcpar_plan_appeals_v1")` first.