Medicaid Managed Care – Individualized Technical Assistance for States
Direct technical assistance is available from the Centers for Medicare & Medicaid Services (CMS) to assist state Medicaid agencies in developing, enhancing, implementing, and evaluating managed care programs.
Examples of areas where states may request direct technical support include:
Managed Care Program Planning & Procurement
- Federal managed care authorities and waiver applications
- Rate setting and risk adjustment
- Managed care organization (MCO) contracting and purchasing
- Stakeholder engagement
Access, Quality and MCO Financial Monitoring and Oversight
- Developing standards and measuring provider network adequacy
- Quality measurement, reporting, and improvement
- MCO financial oversight
- Monitoring and enforcing MCO compliance with contract provisions
- Ensuring program integrity and preventing fraud and abuse in MCOs
Benefit Design & Specialized Services and Populations
- Behavioral health services
- Behavioral and physical health integration
- Dual eligibles and managed care
- Managed long term services and supports
- Other, i.e. dental, transportation, pharmacy
Beneficiary Enrollment, Education, and Rights
- Beneficiary education/information
- Contracting with enrollment brokers
- Developing and implementing auto-enrollment/auto-assignment strategies
- Managing grievances and appeals
Data
- Analyzing data for performance measurement
- Developing or implementing information technology and systems
- Encounter data collection and validation
To request technical assistance, states should reach out to: