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

529
Allowing beneficiaries to continue relationships with an established provider can
also address the need for knowledgeable, experienced primary care providers. One
strategy to ensure continuity is to enroll the beneficiary into a plan that contracts
with the beneficiary's current provider. Many states include information about
provider/plan affiliation in the enrollment material provided to the enrollee or
provide access to a data base of provider affiliations during face-to-face enrollment
counseling. The next step is to ensure that the enrollee can use the provider as the
enrollee's primary care provider once the individual joins the selected plan.
California, for example, specifies newly enrolled members wishing to maintain a
relationship with a provider in the plan's network must be assigned to that
provider.
Finally, the "conceptual framework" developed for the New England States
Demonstration Projects for Dually Eligible Personss recommends that specialists,
registered nurses, nurse practitioners or care coordinators be able to perform many
of the functions of a primary care practitioner. The framework indicates that
consumers with minimal health needs and significant psycho-social needs will
require extensive community-based services and coordination of health and long
term care services which do not require a physician. The alternative primary care
practitioner would notify the physician when a need for medical services occurred.
Physical Access and Communications Requirements
Some members of special populations have physical access and communication
needs that plans must address. Some enrollees use wheelchairs, walkers, or need
other assistance. Others may be blind, deaf, or need specially adapted
communication equipment. To address the needs of many people with disabilities,
plans will need special communication methods (interpreters for people with
hearing impairments, TDD, resources for people with visual impairments, as well
as assistance for people with cognitive impairments). Plans must not only provide
these types of services, but they must also ensure that enrollees who use these
services can access care.
Language requiring that all facilities comply with the ADA may be part of the
contract boilerplate but there is often little review to ensure compliance. As
<strong>Medicaid</strong> managed care programs enroll more people with disabilities, these
requirements warrant increased attention. Contract language might be considered
that describes how plans must review and document the accessibility of providers in
their network.
5 The conceptual framework describes a cQmmon approach to selected issues that will be
taken by each of the six New England states in their waiver demonstration proposals to integrate care for
dual eligibles.
The National Academy for State Health Policy e Q 8/97 IV-26