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

More documents

Recommendations

Info

APPENDIX 14StateReturn Completed <strong>Survey</strong> to:FY 2011 MEDICAID MANAGED CARE SURVEYVsmith@healthmanagement.com (email preferred)(Or mail or FAX to: Vernon K. Smith, Ph.D., Health Management Associates,120 N. Washington Square, Suite 705, Lansing, MI 48933; FAX: (517) 482-0920)If you have any questions, please call Vern Smith at (517) 318-4819.NamePhone Email DateThis survey of state Medicaid agencies is being conducted by Health Management Associates for the <strong>Kaiser</strong> Commissionon Medicaid and the Uninsured to determine the nature and scope of state Medicaid managed care programs andrelated policies currently in place. The survey comprises the following seven sections; many states will not need tocomplete all sections:I. Managed Care Overview: All states should complete this section.II. Comprehensive Risk-Based Managed Care: Only states contracting with comprehensive risk-basedmanaged care organizations (RB-MCOs) should complete this section.III. Primary Care Case Management (PCCM): Only states operating a Primary Care Case Management (PCCM)program should complete this section.IV. Non-Comprehensive Prepaid Health Plans: Only states contracting with non-comprehensive prepaidhealth plans (PHPs) should complete this section.A Prepaid Health Plan (PHP) refers to a type of managed care plan that provides less thancomprehensive services on an at-risk or other-than-state-plan reimbursement basis. There are twoPHP types. A Prepaid Inpatient Health Plan provides, arranges for or otherwise has responsibility forthe provision of any inpatient hospital or institutional services. A Prepaid Ambulatory Health Plandoes not provide any inpatient or institutional services. Common PHP examples include plansproviding only behavioral health services or only dental services.V. Quality: All states contracting with comprehensive RB-MCOs or non-comprehensive PHPs, or operating aPCCM program should complete this section.VI. Special Initiatives: All states should complete this section.VII. Looking Ahead: All states should complete this section.K A I S E R C O M M I S S I O N O NMedicaid and the Uninsured1HEALTH MANAGEMENT ASSOCIATES
I. MANAGED CARE OVERVIEW1. Total Managed Care Enrollment as of October 1, 2010. Please provide monthly enrollment numbersfor October 2010. (If October 2010 data are not available, please provide data for the most recent month forwhich data are available, which is the month of .) Note: If data are not available for the indicatedeligibility groups, please report readily available enrollment data and briefly describe differences under“Comments.”Eligibility GroupTotal Medicaidenrollment: FFS +managed careNumber enrolled in:ComprehensiveRB-MCOs PCCM PHPsUnduplicatedcount of managedcare enrolleesa. All childrenIfavailable:b. SSIChildrenc. Fosterchildrend. MedicaidexpansionCHIPe. Pregnancy Medicaidf. Parents/ caretakerrelativesg. All non-dual aged,blind and disabledIfavailable:h. Nondualagedi. Childless adultsj. Dual eligiblesk. Other (Please describein comments)l. TotalComments:Instructions: Please check one of the two boxes below. If you check the first box, please complete the remainingquestions in this section. If you check the second box, please skip to Section VI. SPECIAL INITIATIVES.My state does or will operate a RB-MCO, PCCM or PHPmanaged care program in FY 2011.My state does not and will not operate a RB-MCO, PCCM orPHP managed care program in FY 2011. Continue to next question. Go to Section VI. SPECIAL INITIATIVES.K A I S E R C O M M I S S I O N O NMedicaid and the Uninsured2HEALTH MANAGEMENT ASSOCIATES
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 and 58: ConclusionFor over 30 years, state
Page 59 and 60: APPENDIX 2: Summary of Medicaid Man
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: APPENDIX 13: Initiatives to Improve
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?