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

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groups, ombudsman programs hot Hues sample interviews conducted
by consumers, families or advocates, etc.
Although atakeholders should have access to such important data,
NCQA has no standard for making results of member-satisfaction ases
ments public.
b) Clinical Practice Guidelines (QI 5)
The use of clinical guidelines should not result in arbitrary decisions
about service options which ignore the member's wishes. <strong>Managed</strong> care
plans should meet the individual needs and preferences of members.
The NCQA standards on clinical practice guidelines fail to address this
issue.
c) Continuity and Coordination of <strong>Care</strong> (QI 6)
For adults with serious mental illness and children with serious emotional
disturbance, managed behavioral health care plans must be linked
with the various support services provided through other public agencies.
In the standards on continuity and coordination of care, NCQA addresses
only the need for coordination with general medical care.
d) Scope and Content of Clinical QI Activities (QI 7)
NCQA lays out minimum requirements with respect to the relevant
-clinical issues that a plan must assess as part of its quality-improvement
activities. NCQA requires only that three clinical issues be identified
for assessment and evaluation (reduced from five clinical issues in an earlier
NCQA draft). Further, this section of the standards has no focus on
outcome. Public payors will wish to be explicit about which clinical issues
are selected as measures of plan performance and to focus on issues
relevant to the population covered under the public-sector managed care
plan. They will also wish to emphasize outcomes as well as performance
criteria.
e) Intervention and Follow-Up (QI 9)
NCQA requires that managed care entities identify opportunities
for improvement and take action to improve performance regarding specific
practitioner or provider performance issues as well as system-wide
issues. Establishing the details of how system-wide issues are to be identified
and corrected is an important area for public payors, which the
standards do not attempt to address.
NCQA Accreditation Standards for <strong>Managed</strong> Behavioral Healthcare Organizations
POLICY ANALYSIS BY THE BAZELON CENTER FOR MENTAL HEALTH LAW
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