Kaiser Family Foundation Survey on State Medicaid Managed Care ...

More documents

Recommendations

Info

APPENDIX 1: Medicaid Managed Care Models in Operation, by State, October 2010State MCO PCCM PHP No Managed CareAKXAL X XARXAZ X XCA X XCO X X XCT X XDC X XDEXFL X X XGA X X XHIXIA X XID X XIL X XIN X XKS X X XKY X XLAXMA X X XMD X XMEXMI X XMNXMOXMS X XMTXNC X XND X XNEXNHXNJXNM X XNVXNY X XOHXOKXOR X X XPA X X XRI X X XSC X XSDXTN X XTX X X XUT X X XVA X XVTXWA X X XWI X XWV X XWYXTotal 36 31 25 352 00
APPENDIX 2: Summary of Medicaid Managed Care Programs, by StateStateALARAZCACOCTMCO PCCM PHPSSIChildrenFosterChildrenMedicaidExpansionCHIPAll OtherChildrenPregnantWomenParents/CaretakersNon-DualAged1915 (b) Patient First (PCCM) X X X X X X1915 (b) Maternity Care Program X XConnect Care -1115 (b) Waiver X X X X X XTEFRA -1115 (a) Waiver X X XNon-DualBlind/DisabledChildlessAdultsDualEligibles OtherARKids-1115(b) Waiver X X XArizona Health Care CostX X X X X X X X X X X X X XContainment System (ACCESS)County Operated Heath System plansX X X X X X X X X X(1115)2-plan & Geographic Managed CareX X X X X X X X X Xplans (1115)Senior Care Action Network (SCAN)X X(1115)<strong>Family</strong> Mosaic (1115) (PIHP) X X X X<strong>Kaiser</strong> PHP (1115) X X X X X X X X X X XDenver Health X X X X X X X X XPrimary Care Physician ProgramX X(PCPP)Colorado Regional Integrated CareX X X X X X X X X XCollaborativeRocky Mountain X X X X X X X XConnecticut Healthcare forUninsured Kids and Youth (HUSKY)X X X X X X X XDC 1915(b) X X X X X X X X XDE 1 Diamond State Health Plan X X X X X X X X X XHealth Maintenance Organization X X X X X X X X XMediPass X X X X X X X X XChildren's Medical Service Network X X X X X XProvider Service Networks X X X X X X X X XPrepaid Mental Health Plan FL 2X X X X X X X X XChild Welfare Prepaid Mental HealthPlanX X X X X XGAPrepaid Dental Health Plan X X X X X XDisease Management X X X X X X X X XNursing Home Diversion X X X XGeorgia Families X X X X X XGeorgia Better Health Care X X X X X XService Options Using Resources inCommunity Environment (SOURCE)X X X X XNon-Emergency Transportation X X X X X X X X X X XHI 1115 Waiver X X X X X X X X X X X XIAProgram Name(e.g., Popular Name, 1915(b) or1115 Waiver Name)StatewideModelEligibility Groups EnrolledMediPASS X X X X X X X X X XIowa Plan for Behavioral Health X X X X X X X X X X X XHealthy Connections X X X X X X X X X X X53
Page 1 and 2:
kaisercommission onmedicaidand theu
Page 3 and 4:
kaisercommission onmedicaidand theu
Page 5 and 6:
Table of ContentsExecutive Summary
Page 7 and 8: EXECUTIVE SUMMARYMedicaid, the publ
Page 9 and 10: party enrollment brokers to provide
Page 11 and 12: HEDIS©, CAHPS©, and state-specifi
Page 13: ConclusionFor over 30 years, state
Page 16 and 17: from the recession and the slow rec
Page 18 and 19: A note on Medicaid managed care ter
Page 20 and 21: Managed caremodelTable 1: Medicaid
Page 23 and 24: States are increasingly mandating m
Page 25 and 26: States with Medicaid MCOsKey Sectio
Page 27 and 28: States have “auto-assignment” a
Page 29 and 30: excess of a specified threshold for
Page 31 and 32: Dental care and outpatient and inpa
Page 33 and 34: the second trimester, and within th
Page 35 and 36: eported that they limit PCP panel s
Page 37 and 38: States with non-comprehensive PHPsK
Page 39 and 40: Measuring, monitoring, and improvin
Page 41 and 42: seven states required 10 measures o
Page 43 and 44: CAHPS© surveys. North Carolina is
Page 45 and 46: Special initiatives to improve qual
Page 47 and 48: public health efforts to reduce dis
Page 49 and 50: Medicaid managed long-term care and
Page 51 and 52: (e.g., need to credential Adult <st
Page 53 and 54: In many states, broader efforts foc
Page 55 and 56: Looking ahead: Medicaid managed car
Page 57: ConclusionFor over 30 years, state
Page 61 and 62: Program Name(e.g., Popular Name, 19
Page 63 and 64: APPENDIX 3: MCO Contracts, Plan Cha
Page 65 and 66: State(No. ofcontracts)NameEnrollmen
Page 67 and 68: State(No. ofcontracts)NameEnrollmen
Page 69 and 70: APPENDIX 5: MCO Capitation Rate-Set
Page 71 and 72: APPENDIX 7: MCO Network Adequacy Re
Page 73 and 74: State Primary Care Obstetric Care S
Page 75 and 76: APPENDIX 9: Providers Recognized as
Page 77 and 78: APPENDIX 11: PCCM Administrative Se
Page 79 and 80: APPENDIX 13: Initiatives to Improve
Page 81 and 82: I. MANAGED CARE OVERVIEW1. Total Ma
Page 83 and 84: 4. Enrollment Requirements.a. We ar
Page 85 and 86: ii. Please indicate whether the fac
Page 87 and 88: c. Required Providers: We are inter
Page 89 and 90: IV. NON-COMPREHENSIVE PREPAID HEALT
Page 91 and 92: . Does your state use CAHPS© surve
Page 93 and 94: VI. SPECIAL INITIATIVESAll states s
Page 95 and 96: Appendix I: Managed Care Contracts1
Page 97: Appendix II: Clinical Quality Perfo
Page 100: 1330 G S T R E E T NW, W A S H I N
show all

Kaiser Family Foundation Survey on State Medicaid Managed Care ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?