Medicaid Managed Care - U.S. Senate Special Committee on Aging

175
Maryland ought to submit that would be specific to the kinds of
needs of the population the concerns we had, and our desire to
have it cover a variety of populations.
The target milestone dates I would just point out to you because
in the end, we had a very quick process, although in the beginning
we had a very extensive public process. Throughout 1995, we had
meetings throughout the State of Maryland discussing various proposals
and ideas for a waiver. In May 1996, following legislative action
which approved the department implementing the waiver as
designed in this extensive public hearing process, a waiver application
was submitted to HCFA. In December 1996, the State of Maryland
developed the regulations and took them through the legislative
process.
Mr. Scanlon alludes to the fact that all of the protections that
you want for your population should be in the contracts that you
have with your managed care organizations. If you want case management,
that needs to be in the contracts. Maryland's is a little
different system from most of the other States. Everything we want
to hold people accountable for has got to be in absolutely publicly
discussed and publicly adopted regulations. So our contracts tend
to be much shorter and safer than a lot of other States, because
our contracts reference everything in the regulations. So that for
Maryland, if you were to look at what we are requiring and how
we hold people accountable, you need to ask for our regulations
rather than just the short contract document between the State
and the managed care organization, and the managed care organizations
are responsible for everything in the regulations.
We went through the regulatory process last summer, and in October,
we had our waiver application approved by HCFA, so that
we were able to begin to move forward. We chose June 2 as our
beginning enrollment date. That gave us about 6 months to go
through the process of reviewing managed care organizations, making
certain they met all of the requirements of the regulations, and
to begin their service provision on July 1.
At the time we began on June 2, we had six approved managed
care organizations; today, we have eight. Maryland again is a
slightly different process than some other States. One, we did not
do competitive bids because we wanted to protect the historic relationships
of providers, and we did not want to see any historic providers
excluded from the process by having losing bidders versus
winning bidders, and so therefore some of the provider networks
excluded.
Second, the department was actually granted a unique authority
so that where an historic provider is unable by his or her own ability
to obtain a contract with a managed care organization, the department
actually has the authority to assign that provider to a
managed care organization. Because our emphasis and concern was
on continuity of patient relationship and continuity of care, we
wanted to be certain that our recipients could continue to choose
their provider and the organization that provider belonged to.
We went through a very extensive process of holding our managed
care organizations accountable, of having the rates be publicly
known, and any organization willing to accept the State's capitation
rate and meeting all the requirements in the regulations was