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

414
AppeAdt U
Fedo.I aod Stt. Ove0sdht Rota of
Mod Mind Cat
networks, such as maximum times and distances beneficiaries must travel
to reach their primary care physician. In contrast, under a program waiver,
HCFA suggests that states establish a patient-to-primary-care-physician
ratio or that providers be located near beneficiaries. Under demonstration
waivers, HCFA also requires states to provide an overall quality assurance
monitoring plan and, as part of that plan, requires states to specify a
minimum data set of encounter data. This minimum data set must receive
prior HCFA approval. Program waivers, In contrast, have guidelines on
quality assurance programs but not as many specific requirements. For
example, HCFA does not require states to develop encounter data under
program waivers.
Table 11.1 summarizes federal requirements and guidance by selected
accountability measures and processes.
PIF 34
GA;HENM97J6 Mtdi. ME.Vd C- Ae .&.Mtsy