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

* Plans must contain adequate provisions
for rapid-response crisis services, in
cluding clearly fixing responsibility within
the system for the provision of such
services;
, Individuals and families must have access
to grievance and appeal mechanisms
designed to fairly and rapidly
address disputes arising from decisions
made by the managed care entity and
the individual/family;
* The plan must contain appropriate and
adequate safeguards to ensure access
to a broad range of services and supports,
includng 'grandfathering"
participation by exisfing providers during
initial implementation and having appeal
mechanisms for use when providers are
adversely affected by the contracting
decisions of managed care entities;
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, <strong>Managed</strong> care initiatives should be
implemented on a mufti-year basis,
employing, whenever feasible, pilot
projects and interim milestones to assess
the soundness of the approaches
being undertaken; and
, Procedures should be included for updating
the managed care plan as well as
the contracts implementing the plan in
order to accommodate lessons learned
and make necessary adjustments in
provider payments.
<strong>Care</strong>ful system design, based on the preceding
guidelines and principles, is absolutely
essential to ensuring that a coherent,
well-articulated and accountable managed
care system operates in the best interests
of individuals, families and the general
public.
MANAGED CARE ORGANIZATIONS
The selection of entities to serve as managed
care organizations is enormously
important. These entities play a pivotal role
in any managed system. Public policies
governing the procurement of such entities
* Policies Governing MCO Procurement
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must ensure that managed care organizations
meet minimum standards and demonstrate
essential capabilities. People with
disabilities and their families should play a
substantive role in the selection process.
These standards include:
. A mission-based, person- and family-centered organizational philosophy;
* Demonstrated experience in managing the delivery of services and supports for people with
developmental disabilities;
* The delineation of and a central rolefor, people with developmental disabilities and their
families in organizational governance, quality improvement, and evaluation;