State programs

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

medicare_semantic.vw_medicaid_mcpar_plan_appeals_v1·live·semantic_view

Rows

1,380

Columns

101

History

N/A

Card

nocolumns only

Typed tools

What it is

1Plan-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).
2Values are the publisher's numbers;
3NULL 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

Key	Grain
N/A	1One row per performance_year x state x program x reporting period x plan name as the state printed it (plan_name_raw); 2704 PY2023 + 676 PY2024 = 1,380 rows, grain unique (verifier view_grain_unique, Athena 2273b054; rows Athena 21a8eb55).

Columns (101)

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

describe_data_source(source_fqn="medicare_semantic.vw_medicaid_mcpar_plan_appeals_v1")     # the card, live
query_substrate(sql="SELECT * FROM medicare_semantic.vw_medicaid_mcpar_plan_appeals_v1 WHERE <filter> LIMIT 100")

Item	Value
Typed tools that read it	none; raw SQL
Identity key	`performance_year,state_code,program_name_raw,reporting_period_start,reporting_period_end,plan_name_raw`
Join	`how_to_join(source_fqn="medicare_semantic.vw_medicaid_mcpar_plan_appeals_v1")`
Raw door	Athena (read-only via query_substrate): medicare_semantic.vw_medicaid_mcpar_plan_appeals_v1 (pin performance_year and state_code)
Company names	`parent_name` resolve to a permanent Vlada ID: `resolve_entity(text=<name>)`; the company pages hold owners and holdings
Note	Registered 2026-10-06 (MCP product lane) under register w8 medicaid_mcpar_puf from the record's coordinator register card (Data Tracker, PR 3200). Door RAW; the view is the customer surface. Versioned, never overwritten.

This page as markdown: /docs-md/data/medicare_semantic_vw_medicaid_mcpar_plan_appeals_v1.md · every page in one file: /llms-full.txt