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

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III. PRIMARY CARE CASE MANAGEMENTPlease check one of the two boxes below. If you check the first box, please complete the remaining questions inthis section. If you check the second box, please skip to Section IV. NON-COMPREHENSIVE PREPAID HEALTH PLANS.My state does or will operate a PCCM or EPCCMprogram in FY 2011.My state does not and will not operate a PCCM orEPCCM program in FY 2011. Continue to next question. Go to Section IV. NON-COMPREHENSIVEPREPAID HEALTH PLANS.1. Enhanced Primary Care Case Management (EPCCM). Does your state have a PCCM program that itconsiders to be an “enhanced” primary care case management program (EPCCM)?a. If “yes,” please briefly describe the enhanced features included in your state’s EPCCM program:2. Primary Care Providers (PCPs). Please indicate in the table below which providers may be PCPs (other than<strong>Family</strong>/General Practitioners, Internists, and Pediatricians.) If your state has different policies for different PCCMor EPCCM programs, please briefly describe under “Comments.”Comments:Permitted PCP Types(Check all that apply)a. Ob/Gyn e. Nurse practitionerb. Physician specialist f. Physician assistantc. Physician group/clinic g. FQHCd. Nurse midwife h. Other:3. PCP Requirements. Please indicate in the table below other state PCP requirements. (Check all that apply)4. Paymenta. 24 hour/7 day-a-week coverage e. Maximum panel sizeb. Meet state reporting requirements f. Must provide primary carec. Participation in State quality initiatives g. Other (specify):d. Minimum panel size h. Other (specify):a. Please indicate what payment method(s) you use for PCCM or EPCCM reimbursement. If your state has differentpolicies for different PCCM programs, geographic areas or eligibility groups, please briefly describe under“Comments.”i.ii.iii.Comments:Methodology(Check all that apply)Fee-for-service with case management fee ofCapitated for services delivered by PCP withiv.$gatekeeper responsibility for other servicesFee-for-service with shared savings provisionv. Other:Fee-for-service with enhanced visit rateb. Is there a pay-for-performance aspect to reimbursement?i. If “yes,” please briefly describe:5. PCCM Administrative Service Contracts. Please list on Appendix I, Table 2 your state’s PCCMadministrative service contracts, if any.END OF PCCM SECTIONK A I S E R C O M M I S S I O N O NMedicaid and the Uninsured9HEALTH MANAGEMENT ASSOCIATES
IV. NON-COMPREHENSIVE PREPAID HEALTH PLANSPlease check one of the two boxes below. If you check the first box, please complete the remaining questions inthis section. If you check the second box, please skip to Section V. QUALITY.My state does or will contract with a PHP in FY 2011.My state does not and will not contract with a PHP in FY 2011. Continue to next question. Go to Section V. QUALITY.1. Services Provided. Please indicate in the table below the services provided by PHP plans.PHP Plan Services(Check all that apply)a Outpatient behavioral health d. Inpatient detoxification g. Dentalb. Inpatient behavioral health e. Prescription drugs h. Visionc. Outpatient substance abuse f. Non-emergency transportation i. Other:Comments:2. PHP Contractorsa. Please indicate in the table below, by contractor type, the number of non-comprehensive PHPs as of October 1,2010. (Please note that a plan may fall within more than one of the listed categories below.)PHP Typei. Medicaid-only (or predominantly Medicaid/CHIP)ii. Mixed Medicaid/commercialiii. Provider-ownediv. Non-profitv. For-profitvi. Publicly tradedvii. Local (non-national)viii. NationalNumberc. Please list on Appendix I, Table 3 the names of the non-comprehensive PHPs in your state.Comments:END OF NON-COMPREHENSIVE PHP SECTIONK A I S E R C O M M I S S I O N O NMedicaid and the Uninsured10HEALTH MANAGEMENT ASSOCIATES
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kaisercommission onmedicaidand theu
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Table of ContentsExecutive Summary
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EXECUTIVE SUMMARYMedicaid, the publ
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party enrollment brokers to provide
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HEDIS©, CAHPS©, and state-specifi
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ConclusionFor over 30 years, state
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from the recession and the slow rec
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A note on Medicaid managed care ter
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Managed caremodelTable 1: Medicaid
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States are increasingly mandating m
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States with Medicaid MCOsKey Sectio
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States have “auto-assignment” a
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excess of a specified threshold for
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Dental care and outpatient and inpa
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the second trimester, and within th
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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 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: c. Required Providers: We are inter
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
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Kaiser Family Foundation Survey on State Medicaid Managed Care ...

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