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

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Chapter 2
<strong>Care</strong> Delivery
Introduction
Once the broad program outline of the managed care system is designed (as
discussed in the previous chapter), the <strong>Medicaid</strong> agency then needs to decide how
contractors should deliver care and communicate these expectations to them. If the
contractors do not understand <strong>Medicaid</strong>'s expectations they are very unlikely to
meet them. This chapter seeks to assist.state <strong>Medicaid</strong> agencies in this process by
identifying specific strategies states use to define the care delivery system of
programs serving the elderly and persons with disabilities through risk-based
managed care. Of course, the information in the chapter on program planning in
Volume II of this Guide also applies to this population. Indeed give the widely
divergent needs of groups within these special populations, states developing
programs for these populations may wish to devote even more effort to obtaining
public input.
Information in this chapter is pertinent to all risk-based managed care programs that
serve special populations (elderly persons and persons with disabilities)-regardless
of the type of contractor, or the specific subpopulation served. This chapter will
specifically address state options in areas of particular importance in serving elderly
and persons with disabilities such as, access, care coordination, long term care
services, marketing and enrollment, and quality.
For best results, a state should ensure that its care delivery expectations are reflected
throughout the program-in the process used to select health plans, the contract
under which plans will operate and the systems used to monitor managed care
plans. For example, if a state decides to require contracted plans to provide a choice
of two psychiatrists within 20 miles of every enrollee's home:
* the plan should be required to demonstrate this ability during the
selection process-perhaps by supplying a provider list or a map
showing the location of each psychiatrist in the network;
* the plan should sign a contract agreeing to meet that specific
requirement;
* the state should establish monitoring strategies to determine whether
the plan meets that standard-perhaps through monitoring
complaints or periodic network reviews; and
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