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

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Principles for
Accountable
<strong>Managed</strong> <strong>Care</strong>
I. Access to Plans and Services
<strong>Managed</strong> care plans - whether they serve
a broad-based population or have a specialty
focus - have an obligation to help
ensure timely access to quality health care
and appropriate services. Accessibility to
plans means reasonable access for persons
who are poor, disadvantaged or chronically
ill. It also means availability to appropriate
specialty care either within the plan or
through arrangements with non-plan
providers, To promote access to services,
health plans should:
1. not discriminate in enrollment;
2. provide, directly or under arrangements,
a comprehensive benefits plan and
access to an appropriate range of providers
and other health resources;
3. have an open enrollment period
during which persons may be continually
enrolled in a health plan without regard to
pre-existing conditions, health history, or
health status; and
4. develop explicit criteria for access to
specialty care and for the patient's role in
decisions regarding specialty services.
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