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

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member for failure to 'follow plans and instructions for care' even
when the member has participated in treatment planning.
d) Complaints and Grievance Systems (RR 3, RR 4)
The NCQA standards on complaints and grievances provide a broad
outline of an appeals process. However, much more detail will be necessary
for public systems, such as what can be appealed, the standard for
review, criteria to be used by the review panel. member input into the
grievance policies and procedures, member involvement in facilitating
resolution of grievances, specific timelines for resolution of complaints,
continuation of services pending appeal and other issues.
7he Bazelon Center is preparing an issue paper on grieusnre and ap
peals, to be available in summer 1997.
e) Information for Members (RtR 5, RR 6)
Standards regarding information to members overlook problems
many public-sector clients may encounter. Information should be more
accessible (in Braille and on audiotape, in all appropriate languages) and
more readily available (provided in various settings at various times).
Plans should also be required to distribute information on a wider
range of issues, particularly on utilization-review procedures.
For more suggestions on information distribution, see Managing <strong>Managed</strong>
<strong>Care</strong>from the Bazelon Center (see resource list).
f) <strong>Care</strong> of Minors and Adults Adjudicated Incompetent (RR 7)
NCQA standards on these issues, which are of major importance in
public systems, is totally inadequate and merely requires managed care
plans to develop their own policies. Public payors should ensure that
managed care plans follow appropriate laws so that adults exercise their
own rights, unless adjudieated incompetent in court, and that they have
the right to develop advance directives and proxies. Rights for minors
should include appropriate standards for older adolescents to exercise
certain rights on their own behalf.
g) Confidentiality (RR 7)
NCQA standards on confidentiality require that managed care
plans, policies and procedures conform to all federal and-state confidentiality
regulations. Public payors that wish to address other issues will
need to augment the NCQA requirements.
NCQA Accreditation Standards for <strong>Managed</strong> Behavioral Healthcare Organi.aton' 1
POLICY ANALYSIS BY THE BAZELON CENTER FOR MENTAL HEALTH LAW LI