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

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dress this issue and omits requirements for public release of key information,
such as utilization-management procedures, data on grievances and
appeals, and outcome measurements.
Continuity
Adults with serious mental illness and children with serious emotional
disturbance require services from multiple public agencies and
will continue to do so under managed care arrangements. NCQA does
not have adequate standards regarding linkages and collaboration between
managed care plans and other state systems serving the same individuals.
<strong>Special</strong> Populations
A number of special populations who rely on the public sector have
needs that are especially challenging. These groups include people who
live in rural areas or are homeless, elderly or dually diagnosed with mental
retardation and mental illness or with substance abuse and mental illness.
Since public contracts for managed care represent their safety net
for behavioral health care, special attention is required to ensure that
needs particular to each of population are addressed. NCQA does not include
adequate standards for outreach and other specific interventions
for special populations; the NCQA standards will not, therefore, enable
purchasers to determine whether plans are meeting their needs.
Children
Children's needs are different from adults'. The types of services
children receive, the way services are delivered to children and their
families, and the various developmental stages of children present different
challenges to managed care-entities: lirddition to lacking any section
on children's issues, the NCQA standards rarely mention
children's particular needs or address children's service delivery specifically.
While the standards are intended to be generic, it is more accurate
to characterize them as adult-focused.
Notification of Potential Threats to Safety
NCQA's own policies and procedures include a provision that
NCQA will notify the managed care plan's CEO when it identifies a deficiency
in the plan's operations that 'poses a threat to public health or
safety, or to the health or safety of members' (page 20 of Policies and
NCQA Accreditation Standards for <strong>Managed</strong> Behavioral Healthcare Organizations
POLICY ANALYSIS BY THE BAZELON CENTER FOR MENTAL HEALTH LAW
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