Managed Care | Medicaid
Managed Care is a health care delivery system organized to manage cost, utilization, and quality. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these …
Jul 1, 2011 · Care Organization (MCO) per region, to one of island-wide coverage and choice of four (4) MCOs, with the goal of improving access to care and choice of providers. Plan Vital also implemented a model of stratified capitated payments to MCOs, with focused resources for High Cost High Need conditions which is expected to result
Managed Care Entities | Medicaid
Federal Managed Care regulations at 42 CFR 438 recognize four types of managed care entities: Managed Care Organizations (MCOs) Comprehensive benefit package Payment is risk-based/capitation Primary Care Case Management (PCCM)
Managed Care Quality Improvement | Medicaid
Managed Care Quality Improvement. As the dominant delivery system for Medicaid and the Children's Health Insurance Program (CHIP), managed care has enormous potential to achieve state priorities and improve health care quality and outcomes.
a MCO program that covers acute, primary, and specialty services, and prescription drugs contracting health through maintenance organization (HMOs). The CHCP is available statewide on a mandatory basis for most beneficiary groups, including foster care children who were added to the program in 2009, who are enrolled except for dual eligibles
(enrollment is optional for foster care children). MCO availability varies by region, but some plans are available statewide. Behavioral health services are carved out of the PCCM benefit packageand provided through the mental health PHP, while MCO members receive behavioral health care through the MCO plan. In 2004, Massachusetts expanded the
Guidance | Medicaid
As part of the state-federal partnership in administering the Medicaid programs, the Centers for Medicaid and CHIP Services (CMCS) issues technical assistance in the form of letters to State Medicaid Directors, Informational Bulletins, Issue Briefs, and Frequently Asked Questions (FAQs) to communicate with states and other stakeholders regarding operational issues related to …
Managed Care Authorities | Medicaid
States can implement a managed care delivery system using three basic types of federal authorities:State plan authority [Section 1932(a)]Waiver authority [Section 1915 (a) and (b)]Waiver authority [Section 1115]Regardless of the authority, states must comply with the federal regulations that govern managed care delivery systems.
Contract Review | Medicaid
Feb 15, 2022 · The managed care regulation sets forth requirements for states to submit their contracts with managed care plans to the Centers for Medicare & Medicaid Services (CMS) for review and approval.
Profiles & Program Features | Medicaid
These Managed Care State Profiles and State Program Features reflect the most recently available managed care program information.