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

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i. If “yes,” please briefly describe including whether the initiative is/was viewed as successful:d. Please briefly describe any other special managed care quality initiatives or requirements:6. Managed Care Issues. What are your state’s top three priorities or strategies for improving quality and/oraccess in your Medicaid managed care program? Please list below.a.b.c.Comments:END OF QUALITY SECTIONK A I S E R C O M M I S S I O N O NMedicaid and the Uninsured13HEALTH MANAGEMENT ASSOCIATES
VI. SPECIAL INITIATIVESAll states should complete this section.1. Care Management/Disease Management. Please briefly describe any care management or diseasemanagement programs in place in your state or planned for implementation in FY 2011, including the populationor condition/disease covered, a general description of the services provided, and whether the program is part ofa comprehensive RB-MCO or PCCM program:2. Medical Home. Does your state have a medical home initiative in place or under development?a. If “yes,” please briefly describe your state’s:i. Medical home definition:ii. PCP requirements:iii. Payment method:3. Managed Long Term Care.a. Does your state operate a PACE (Program for All-Inclusive Care for the Elderly) program? If “yes”:i. How many PACE sites were in place as of October 1, 2010?ii. How many PACE enrollees were there in October 2010 (or the most recent month available):b. Does your state operate one or more managed long term care (MLTC) programs (other than PACE) as of October1, 2010? If ”yes”:i. Enrollment. Please provide monthly enrollment numbers for October 2010, or the most recent monthavailable for all MLTC programs (other than PACE): . (Please provide the month of the enrollmentdata if other than October 2010: )ii. Payment. Please briefly describe the payment methodology:iii. Benefits. Please briefly describe the benefits included (e.g., institutional services, home and communitybasedservices, etc.):iv. Issues/Concerns: Please briefly describe any issues or concerns that have arisen in your state relating toMLTC over the past 12-18 months:4. Dual Eligiblesa. Please briefly describe any managed care arrangements applicable to dual eligibles in your state currently inplace or under development and whether enrollment is mandatory or voluntary:b. Please briefly describe any other dual eligible initiative or program planned or under development in your stateincluding the role, if any, that managed care organizations would play:c. During FY 2011, will your Medicaid program contract with Medicare Advantage Special Needs Plans (SNPs)?5. Accountable Care Organizations. Please briefly describe any accountable care organization initiative orprogram planned or under development in your state including the role, if any, that managed care organizationswould play:END OF SPECIAL INITIATIVES SECTIONK A I S E R C O M M I S S I O N O NMedicaid and the Uninsured14HEALTH MANAGEMENT ASSOCIATES
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kaisercommission onmedicaidand theu
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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
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States with non-comprehensive PHPsK
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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 and 88: c. Required Providers: We are inter
Page 89 and 90: IV. NON-COMPREHENSIVE PREPAID HEALT
Page 91: . Does your state use CAHPS© surve
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
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Kaiser Family Foundation Survey on State Medicaid Managed Care ...

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