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

14
people with disabilities and special health care needs. This includes such basic benefits as
prescription drugs, preventive services, rehabilitation services, durable medical equipment,
orthotics and prosthetics, and mental health services
<strong>Managed</strong> care systems/plans must offer all necessary benefits, services, and supports across
multiple settings, such as home, school, work. There must be no arbitrary limitations on service
settings.
<strong>Managed</strong> care systems/plans must not include disincentives, financial or otherwise, to the
provision of services in home and community-based settings.
<strong>Managed</strong> care systems/plans must be structured to ensure continued, appropriate access to health
and health related services.
Services should be provided not only to treat acute and chronic conditions but also to promote
and maintain health and optimum functioning and prevent deterioration and secondary disabilities.
<strong>Managed</strong> care systems/plans must have specific limits on waiting times for first appointments and
for specialty referrals. To assure geographic accessibility of services, there must also be
established standards for travel times and distances to both primary and specialized services.
Access to <strong>Special</strong>ty Services
<strong>Managed</strong> care systems/plans must provide for access to and the effective coordination of
specialized services with other systems/supports on which people with disabilities rely.
<strong>Managed</strong> care systems/plans must offer people with disabilities and special health care needs the
option of having a specialist-as their "gatekeeper" in the system/plan. This specialist would
provide both necessary specialized services -- at the specialized rate -- and primary care services
-- at the lower primary care reimbursement rate.
Strong Quality Assurance Measures
<strong>Managed</strong> care systems/plans must comply with the protections offered by Section 504 of the
Rehabilitation Act of 1973, as amended, the Americans with Disabilities Act, and-other civil
fights statutes.
<strong>Managed</strong> care systems/plans must provide participants with clear information on policies,
procedures, grievance mechanisms, and appeals and must ensure consumer participation in the
establishment of such procedures.
<strong>Managed</strong> care systems/plans must provide access to independent organizations that provide
ombudsman and rights protection services.
<strong>Managed</strong> care systems/plans must have in place a mechanism for responding to adverse utilization
United Cerebral Palsy Associations Page 7 of 9