Environmental Scan of MLTSS Quality Requirements in MCO Contracts. II. Scan Methodology

09/01/2013

Our source data for the scan were the standard contracts that states use to engage MCOs to provide MLTSS in their Medicaid programs. These documents are available on state websites and other public domains.

In developing the data collection tool for this exercise, we relied upon three main sources for identifying key features of quality design and management for MLTSS: (1) the Centers for Medicare and Medicaid Services' (CMS') recently released guidance to the states on the design of Medicaid 1115 Demonstration and 1915(b) Waivers as vehicles for Medicaid MLTSS programs;2 (2) quality requirements associated with the 1915(c) Home and Community-Based Services (HCBS) Waiver program3 which are often imbedded within the Terms and Conditions to which states seeking approval of 1115 waivers must agree, and which are required when states operate "combo" waivers (typically using 1915(c) waiver authority with 1915(a) or (b) waiver authority); and (3) quality-related federal requirements specified in the regulations that govern Medicaid managed care (Code of Federal Regulations [CFR] 438).4

As many of the contracts are very large (running into hundreds of pages), it would have been too labor intensive to read through the entirety of each contract. Instead, we relied on the contracts' tables of content to locate contract requirements of interest. We also employed document search functions using a range of appropriate terminology for each quality element in the scan.

The scan included MCO contracts developed by the following 17 states for their MLTSS Programs.

Arizona Arizona Long-Term Care System (ALTCS)
Delaware Diamond State Health Plan-Plus (DSHP-Plus)
Florida Long-Term Care Community Diversion Pilot Project
Hawaii QUEST Expanded Access (QExA)
Illinois Integrated Care System Program (ICSP)
Kansas KanCare
Massachusetts   Massachusetts Senior Care Options
Michigan Medicaid Managed Specialty Supports and Services
Minnesota Minnesota Senior Care Plus (MSC+) and Minnesota Senior Health Options (MSHO)  
New Mexico Coordination of Long-Term Services (CoLTS)
New York Medicaid Advantage Plus (MAP)
North Carolina MH/DD/SAS Health Plan Waiver
Pennsylvania Adult Community Autism Program (ACAP)
Tennessee TennCare CHOICES in LTSS
Texas STAR+PLUS
Washington Washington Medicaid Integration Partnership (WMIP)
Wisconsin Family Care

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