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

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* MCOs may not solicit or sign up members directly.
* Foundation Health Federal Services, Inc., the state's
enrollment broker, will distribute the recipient
enrollment packets. The packets will include:
information on the MCOs in the recipient's area;
provider lists and locations;
a Health Risk Assessment for each family member; and
MCO report cards based on patient satisfaction surveys.
* Health care services include inpatient care, outpatient
care, primary care physician visits, pharmacy access
and other ancillary services.
Some MCos may offer dental services to adults as well
as children.
* HealthChoice members will be able to self-refer for family
planning services and access school-based health suites
for care.
* HealthChoice MCOs will be responsible for primary mental
health services.
More intensive mental health will be handled by a
separate mental health system administered by the DHMH
Mental Hygiene Administration (MHA) through regional
Core Services Agencies.
* Each HealthChoice MCO is required to have a consumer
advisory board and provide an internal grievance
procedure.
* DHMH will implement a statewide grievance/appeals process
including an ombudsman service at the local health
department and a toll-free hotline for recipient
questions.
- * - MCOs may either be Health Maintenance Organizations (HMOs)
or non-HMOs that meet state established quality-of-care
criteria and financial solvency standards.
* Physicians, clinics, <strong>Medicaid</strong> HMOs and provider-bases
organizations with a demonstrated history of
successfully serving <strong>Medicaid</strong> recipients are guaranteed
participation in HealthChoice.