Medicaid Managed Care - U.S. Senate Special Committee on Aging
Medicaid Managed Care - U.S. Senate Special Committee on Aging Medicaid Managed Care - U.S. Senate Special Committee on Aging
Conclusions B-276D78 490 Safety-net providers in Fresno County were particularly concerned about their viability since the county's two-plan model did not include a local initiative. An agreement was reached between the state, providers, and the two commercial plans that addressed some of the short- and long-term concerns of these safety-net providers. For example, the two plans agreed to assign all state-assigned beneficiaries who had not designated a primary care physician to a safety-net provider. Over the longer term, a special team composed of state, plan, and provider representatives will be established to oversee the implementation of managed care in Fresno County. California's expansion of its Medi-Cal managed care program is currently the largest effort of its kind in the nation in terms of the number of beneficiaries involved. Although California invested nearly 5 years in both conceptual and implementation planning of its two-plan mandatory program, implementation has not been smooth. Many of the circumstances that contributed to implementation problems were within the state's control, while others were not For example, the timing of the transition from one enrollment broker to another undoubtedly contributed to the implementation delays and difficulties. Had the transition not occurred in the midst of the two-plan implementation in several counties, some problems might have been less severe. Many of the problems that occurred in implementing the new mandatory program were foreshadowed by the state's earlier efforts to implement managed care. These earlier problems-documented in prior evaluations by other organizations-should have convinced the state that many of its policies and procedures needed retooling. The state is now taking certain actions to improve the program, but many are too late to benefit those beneficiaries already enrolled in the seven counties where implementation has been completed. HCFA'S preimplementation reviews enabled llcFA to identify problem areas in California's implementation of its two-plan model; the reviews did not, however, always result in immediate improvements. At the same time that tis was attempting to address these problems, managed care plans were exerting pressure to push ahead with program implementation since their large investments-and financial viability-were dependent on receiving enrollments and associated revenues according to set time frames. As a result, while HCFAs identified the need for significant improvements, it did not halt program implementation to effect such changes. iceFA also did not Psp 24 C24GA04HS-9s-2 M ugd CapEp..' c ,
Recommendation Agency Comments and Our Evaluation B-r760 491 have sufficient written guidance in place to assist the state in developing and implementing its program. Despite these delays and difficulties, California's experience can be instructive for other states as they develop, expand, or adapt their mandatory
- Page 442 and 443: 440 We are sending copies of this r
- Page 444 and 445: C-m 442 Table 2: Changes in Number
- Page 446 and 447: 444 App-ar I So-p and Mraodsogo ent
- Page 448 and 449: 446 Appendix H Medicaid</st
- Page 450 and 451: 448 App-di. f M~I Wd., _. So 4 Of0
- Page 452 and 453: 450 App-.i. il _-.1 - Desd s UCFVA'
- Page 454 and 455: 452 Apeadls mn Stadad Seee - Defind
- Page 456 and 457: 454 Appedi. M St.d.ed Se&ee s Dneoe
- Page 458 and 459: Chore 456 Am..& IV LAO n.Gd .Mt. ,
- Page 460 and 461: Occupational Therapy and Assessment
- Page 462 and 463: Psychological Services Provider Typ
- Page 464 and 465: 462 AWppdi IV U-e, Cotfi-, E d Othe
- Page 466 and 467: Licensure/Registration Other Standa
- Page 468 and 469: 466 United States General Accountin
- Page 470 and 471: Results in Brief B-276078 468 care
- Page 472 and 473: B-270078 470 Medi-Cal was implement
- Page 474 and 475: _.27_7 Tab 1: Mad-C Eiglbli and Enr
- Page 476 and 477: ~~- - o~~BZ760?S 474 I J I the enro
- Page 478 and 479: B.276078 476 delaying the contracti
- Page 480 and 481: State's Education Process Has Not R
- Page 482 and 483: B.276078 480 and thereby supplement
- Page 484 and 485: Weaknesses in State Management of t
- Page 486 and 487: B-276078 484 standards can provide
- Page 488 and 489: Insufficient Communication and Invo
- Page 490 and 491: Some Safety-Net Providers Are Encou
- Page 494 and 495: B-270078 492 current enrollment bro
- Page 496 and 497: Contents Letter 494 Appendix 30 Sco
- Page 498 and 499: (1115) oPP. -.M.taoy 496 oversight
- Page 500 and 501: 498 ACKNOWLEDGEMENTS This Volume of
- Page 502 and 503: 500 Is Lock-in to a Managed
- Page 504 and 505: 502 Plan and Provider Issues ......
- Page 506 and 507: 504 Chapter 1 Program Design Issues
- Page 508 and 509: 506 Other studies attest to improve
- Page 510 and 511: 508 Will the Program Be Voluntary o
- Page 512 and 513: 510 additional option for people wi
- Page 514 and 515: 512 contractor collect spenddown pa
- Page 516 and 517: 514 Option A is still quite rare. P
- Page 518 and 519: 516 experience with special populat
- Page 520 and 521: 518 particularly on a full risk bas
- Page 522 and 523: 520 Dual eligibility raises a disti
- Page 524 and 525: 522 special populations, and states
- Page 526 and 527: 524 Chapter 2 Care
- Page 528 and 529: 526 settings. Finally, plans that s
- Page 530 and 531: 5281 needs. For example, women who
- Page 532 and 533: 530 Oregon's rules require that pla
- Page 534 and 535: 532 beneficiaries on July 1, 1997.
- Page 536 and 537: 534 facility's delivery, dosage, an
- Page 538 and 539: 536 * Strategies for measuring netw
- Page 540 and 541: 538. arrangements with traditional
Recommendati<strong>on</strong><br />
Agency Comments<br />
and Our Evaluati<strong>on</strong><br />
B-r760<br />
491<br />
have sufficient written guidance in place to assist the state in developing<br />
and implementing its program.<br />
Despite these delays and difficulties, California's experience can be<br />
instructive for other states as they develop, expand, or adapt their<br />
mandatory <str<strong>on</strong>g>Medicaid</str<strong>on</strong>g> managed care programs. Specifically, California's<br />
cxpcHrcncc points to secvral potcntial less<strong>on</strong>s learned:<br />
Incremental implementati<strong>on</strong> allows for adjustments and improvement<br />
Simultaneous or quick-successi<strong>on</strong> implementati<strong>on</strong> in multiple areas does<br />
not give sufficient time for program modificati<strong>on</strong>s when unforeseen<br />
problems arise.<br />
Sufficient staff-including individuals who have expertise in managed care<br />
program design and implementati<strong>on</strong>-are needed to c<strong>on</strong>duct program<br />
activities. Of particular importance are systems analysts and c<strong>on</strong>tract<br />
specialists.<br />
Stakeholder and community input and involvement, sought early and<br />
often, can c<strong>on</strong>tribute significantly to effective educati<strong>on</strong> and enrollment<br />
processes and problem resoluti<strong>on</strong><br />
Effective m<strong>on</strong>itoring systems, including adequate management<br />
informati<strong>on</strong> and reporting, can ensure accountability for program<br />
operati<strong>on</strong>s-especially if there is heavy reliance <strong>on</strong> a c<strong>on</strong>tractor for<br />
integral parts of the program. Including performance standards for key<br />
areas of operati<strong>on</strong> in enrollment broker c<strong>on</strong>tracts and tying these<br />
standards directly to broker payment might help to ensure maximum<br />
c<strong>on</strong>tractor performance.<br />
To help states design and implement <str<strong>on</strong>g>Medicaid</str<strong>on</strong>g> managed care programs<br />
that ensure beneficiaries who enroll-especially those who are mandated<br />
to do so-are able to make an informed choice in selecting a plan, we<br />
recommend that the Secretary of Health and Human Services direct HCFA<br />
to promptly finalize guidelines for developing and operating an educati<strong>on</strong><br />
and enrollment program. To help ensure accountability, these guidelines<br />
should include c<strong>on</strong>siderati<strong>on</strong>s regarding appropriate performance<br />
standards and measures and m<strong>on</strong>itoring mechanisms, especially when a<br />
state c<strong>on</strong>tracts out these functi<strong>on</strong>s to an enrollment broker.<br />
We provided a draft of this report to the Administrator, crFA; Director,<br />
California Dus; and officials of Benova and Maximus, the former and<br />
P.V 25<br />
GA021EHS 98-2 Chuf<strong>on</strong>d.. M.oqod Co Eop-A..<strong>on</strong>
Change language