INTRODUCTION
Chapter 1: UNDERSTANDING YOUR STATE'S MEDICAID MANAGED CARE PROGRAM
I. Why is it important to understand your State's Medicaid managed care program?
A. To find out the status of the program
B. To influence future decisions
II. How can the Provider obtain this information?
A. The State Title V/CSHCN Agency
B. Other MCH/CSHCN Providers
C. The State Medicaid Agency
III. What questions should the Provider ask its State Medicaid Agency?
A. General Medicaid managed care questions
B. MCH-Specific Medicaid managed care questions
C. Questions on payment mechanisms
Checklist
Self-Assessment Quiz
Chapter 2: UNDERSTANDING MANAGED CARE ORGANIZATIONS
I. What does a Provider need to know about MCOs?
II. What should a Provider know about MCO's perspective?
A. Enrollment/eligibility factors
B. Cost factors
C. Administrative simplicity
D. State's licensure requirements
E. Medicaid managed care program requirements
F. Delivery system structure
III. What is an MCO looking for in a Provider?
A. Assistance in meeting Medicaid contracting requirements
B. Assistance in enhancing the image of the MCO
C. Assistance in reducing costs
D. Assistance in marketing the MCO
Checklist
Self-Assessment Quiz
Chapter 3: EVALUATING ADMINISTRATIVE CAPACITY AND SELECTING THE MOST APPROPRIATE CONTRACTING AGREEMENT
I. What administrative capacities are necessary?
A. Administrative Efficiency
B. Response Mechanisms
C. Billing Capacity
II. What is the most appropriate contracting arrangement?
A. Contracting with the MCO directly vs participating in a coalition
B. Key questions to ask
III. What issues arise in subcontracting services?
A. Willingness and ability of subcontracting organizations to collaborate
B. Subcontractor rights and responsibilities
Checklist
Self-Assessment Quiz
Chapter 4 : SELECTING THE SERVICES TO OFFER TO AN MCO
I. What are the steps in developing an MCO proposal?
II. What is the purpose of developing a Mission Statement for a managed care environment?
III. Which services should the Provider consider offering?
IV. What should the Provider know about the MCO?
A. Gathering information
B. Requesting a preliminary meeting with the MCO
C. Preparing questions for the preliminary meeting
D. Evaluating the desirability of contracting with the MCO
V. Does the Provider have the necessary service capacity?
Checklist
Self-Assessment Quiz
Chapter 5: HOW TO DEVELOP A MANAGED CARE PROPOSAL
I. What is the objective of the proposal?
II. What should be included in the proposal?
A. Key components
B. Background information
C. Packaging services
D. Pricing services
E. Levels of risk
F. Limiting or managing risk
G. Other areas to address in the proposal
Checklist
Self-Assessment Quiz
Chapter 6: PROPOSING, MARKETING, AND NEGOTIATING A MANAGED CARE CONTRACT
I. How does the Provider develop a strategy for obtaining an MCO contract?
II. How does the Provider market its managed care proposal?
III. How should the contract be drafted?
A. Preparing the initial draft
B. Selecting the type of contract
C. Addressing operational issues
D. Other drafting issues to consider
Checklist
Self-Assessment Quiz
APPENDICES
Appendix A..........Contract Between MCH/CSHCN Provider and MCO
Appendix B..........Letter Agreement Between MCH/CSHCN Provider and MCO
Appendix C..........Contract Between MCH/CSHCN Provider and Subcontractor
Appendix D..........Glossary of Managed Care Terms
Appendix E..........State and Federal Medicaid Contacts