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

B-2787U
489
'proportionately' assigns such beneficiaries.a According to Dis, it did not
require plans to assign a specific number of beneficiaries to safety-net
providers because federal law requires states to ensure that beneficiaries
have a choice of providers.
Despite these protections, an initial assessment of the two-plan models
impact on safety-net providers suggasts that some are experiencing
difficulties, especially in maintaining their levels of enrollmenL According
to the state and ilca, a couple of factors have affected safety-net
providers' enrollment bases. Beneficiaries in managed care are required to
designate only one provider as their primary care physician, although they
may have visited more than one provider in fee-for-service care.
Consequently, some safety-net providers say that they have seen fewer
beneficiaries under the two-plan model. However, many beneficiaries who
choose a provider are not choosing safety-net providers, and many who
are assigned to these providers disenroll. HCFA has reported that in Los
Angeles County, 12,600 beneficiaries-or 70 percent-who had been
assigned to a safety-net provider chose to disenroll within 5 days.
The two-plan model does not prescribe, other than in general terms, how
plans are to assign beneficiaries to individual providers. However, a
number of plans favor safety-net providers in their assignment
methodology. One plan had designed a four-tier assignment methodology
that gives priority to contracted safety-net providers and other providers
that have at least a 50-percent Medi-Cal enrollment base. Another plan
seeks to maintain a 60/40 assignment ratio, with approximately 60 percent
of beneficiaries assigned to private providers and the remaining 40 percent
assigned to county and community clinicsa 3 '
State Assessing Safety-Net The state has begun to assess measures that could be taken to assist
Issue and Taking Some safety-net providers and has taken action in one county. To reduce the
Steps to Assist Providers number of beneficiaries assigned by plans away from their safety-net
providers, the state planned to provide information on beneficiaries last
provider of record to plans beginning August 1997. With this information,
plans could assign the beneficiary to that provider if the provider was part
of the plan's network.
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