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

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ewrise satisfies the standardsfor medically necessary services, as setforth
herein and in Sections (A), (B), ()), (E), (9 and (G);
(d) in conformance with any psychiatric advance directive the Menser
has prepared;
(e) delivered in a timely manner, with an immediate response in emergencies
in a location that is convenient and accessible to Members;
( responsive to unique needs of linguistic and cultural minorities and
furnished in a culturally relevant manner;
(gi responsive to the unique needs of people with mental andphysical impairments
andfurnised with accommodations to their needs, as required
under the Ameicans with Disabilities Act and other applicable law;
(h)providedin the least restrictive appropriate setting; inpatient and residenrial
treatment shall be used only when all less restrictive levels of treatment
have been unsuccessful or cannot be safely provided;
(7) provided in the Member's home or home community, except in limited
extraordinary circumstances;
a) designed (when relevant) to prevent the needfor involuntary treatment
or institutionalization;
(k)provided in a manner thatfacilitates continuity and coordination of
services within a system of care;
(I)furnisbed so as to include referrals to and coordination with agencies
providing other relevant services to the Member, includingproviders of
other health care services, social service providers, education providers, preschool
and child care providers and vocational rehabilitation providers;
(m) consistent with national standards of practice, including standards
of practice in community psychiatry andpsychiatric rehabilitation, as defined
by standard clinical reffrences, generally acceptedprofessional practice
or empirical professional experience;
(n) consistent with theplan's Quality Assurance standards andprocedures,
and its placement criteria, in Sections _ of the contract; and
(o) consistent with the standardsfor confidentiality in Section _
the contract.
of
D. Additional Standards for Children
Not all managed behavioral health care plans include children. In
some states, children's services are left in the traditional state system or
provided through a separate managed care plan. Any managed care plan
that covers children and adolescents must address several-unique issues.
Defining 'Medically Necessary" Services to Protect Plan Members N
POLICY ANALYSIS BY THE BAZELON CENTER FOR MENTAL HEALTH LAW