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APPENDIX L. NORTH CAROLINA MENTAL HEALTH/

Environmental Scan of MLTSS Quality Requirements in MCO Contracts. Appendix L. North Carolina Mental HEALTH/DEVELOPMENTAL DISABILITIES/SUBSTANCE Abuse Services Health Plan Waiver

  Element     Description/Notes   State and Lead Agency North Carolina Department of Health and Human Services (DHHS), Division of Medical Assistance (DMA)
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APPENDIX K. NEW YORK MEDICAID ADVANTAGE PLUS

Environmental Scan of MLTSS Quality Requirements in MCO Contracts. Appendix K. New York Medicaid Advantage Plus

  Element     Description/Notes   State and Lead Agency New York State Department of Health (SDOH), Division of Long-Term Care
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APPENDIX J. NEW MEXICO COORDINATION OF LONG-TERM

Environmental Scan of MLTSS Quality Requirements in MCO Contracts. Appendix J. New Mexico Coordination of Long-term Services

  Element     Description/Notes   State and Lead Agency New Mexico Human Services Department (HSD) New Mexico Aging and Long-Term Services Department (ALTSD)
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APPENDIX I. MINNESOTA SENIOR CARE PLUS AND

Environmental Scan of MLTSS Quality Requirements in MCO Contracts. Appendix I. Minnesota Senior CARE Plus and Minnesota Senior Health Options

  Element     Description/Notes   State and Lead Agency Minnesota Department of Human Services
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APPENDIX H. MICHIGAN MEDICAID MANAGED SPECIALTY

Environmental Scan of MLTSS Quality Requirements in MCO Contracts. Appendix H. Michigan Medicaid Managed Specialty Supports and Services

  Element     Description/Notes   State and Lead Agency Michigan Department of Community Health (MDCH)
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APPENDIX D. HAWAII QUEST EXPANDED ACCESS

Environmental Scan of MLTSS Quality Requirements in MCO Contracts. Appendix D. Hawaii Quest Expanded Access

  Element     Description/Notes   State and Lead Agency Hawaii Department of Human Services, MED-QUEST Division
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APPENDIX A. ARIZONA LONG-TERM CARE SYSTEM

Environmental Scan of MLTSS Quality Requirements in MCO Contracts. Appendix A. Arizona Long-term CARE System

  Element     Description/Notes   State and Lead Agency Arizona Health Care Cost Containment System (AHCCCS)
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III. SCAN HIGHLIGHTS

Environmental Scan of MLTSS Quality Requirements in MCO Contracts. III. Scan Highlights

Below we highlight what the scan revealed about the quality requirements MLTSS states choose to include in contracts with MCOs. In some instances there is wide diversity in what the contracts require and in others more convergence. Also, contracts may require the same quality element but one may be very prescriptive and specific about how the requ
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EXECUTIVE SUMMARY

Environmental Scan of MLTSS Quality Requirements in MCO Contracts. Executive Summary

Contracts with managed care organizations (MCOs) in 17 states were reviewed. The scan of managed long-term services and supports (MLTSS) quality requirements revealed wide diversity in some instances and in others more convergence. Also, whereas contracts may require the same quality elements, in one state the requirement may be very specific and
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ACRONYMS

Environmental Scan of MLTSS Quality Requirements in MCO Contracts. Acronyms

The following acronyms are mentioned in this report and/or appendices.
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Environmental Scan of MLTSS Quality Requirements

Environmental Scan of MLTSS Quality Requirements in MCO Contracts

This report describes how frequently various quality requirement elements appear in managed care organization contracts, as well as some similarities and differences in the quality requirements.
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A. Progress in Measuring and Understanding Long-

An Investigation of Interstate Variation in Medicaid Long-Term Care Use and Expenditures Across 40 States in 2006. A. Progress in Measuring and Understanding Long-Term Care System Performance

1. Measuring Progress
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An Investigation of Interstate Variation in

An Investigation of Interstate Variation in Medicaid Long-Term Care Use and Expenditures Across 40 States in 2006

State long-term care (LTC) financing and delivery systems and, in particular, Medicaid funded LTC have long been criticized for being “institutionally biased.” Shifting the balance in publicly-funded long-term care provision away from institutional care (nursing homes, long-term hospitals, intermediate care facilities for the intellectually di
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5.2. Independence, Employment, Education, and

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 5.2. Independence, Employment, Education, and Health

SDC participants would be expected to have greater functional and residential independence and greater participation in competitive employment and education compared to participants in traditional mental health services. SDC programs are designed to advance these recovery goals through the person-centered planning process. SDC would, for example,
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4.5. Ensuring that the Quality of Care is

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 4.5. Ensuring that the Quality of Care is Maintained or Improved

One of the rationales for the SDC approach is that giving participants the freedom to make choices, whether good or bad, encourages personal responsibility and independence. As a result, some participants in SDC may use individual budgets to select treatment interventions that psychiatrists and psychologists would consider misguided or potentially
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4.1. Ensuring that Participation is Equitable

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 4.1. Ensuring that Participation is Equitable

SDC models automatically place consumers of mental health services "in the driver's seat" 2 by making them the primary decision-makers in choosing services and providers and by giving them authority over an individual budget. Although this structure supports consumers' autonomy and self-direction, it also demands greater consumer involvement in
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E. Covered Populations and Services

Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States. E. Covered Populations and Services

Enrollment process . There is no formal enrollment process for patients; rather, PCPs enroll into Blueprint. All types of PCPs are eligible to enroll, but they must meet NCQA standards to be recognized as a PCMH and receive quality incentive payments. Vermont recognizes multiple provider specialties as PCPs, including internal medicine, general m
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D. Program Financing and Contracting

Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States. D. Program Financing and Contracting

The central Blueprint payment reforms--payments to incentivize quality (rather than volume) and enhance capacity through core CHT members--are financed through payments made to practices from the state's public and private insurers. Practices receive these payments on top of payments for health care provision.
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ACRONYMS

Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States. Acronyms

The following acronyms are mentioned in this report and/or appendix.
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Strategies for Integrating and Coordinating Care

Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States

This report describes the different strategies that four states--Louisiana, North Carolina, Tennessee and Vermont--are utilizing to improve the integration and coordination of care for individuals with mental health and substance use disorders. These strategies include introducing new managed care arrangements and care coordination mechanisms, enh
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