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Centennial Care 2.0 MCO Readiness

Centennial Care 2.0 MCO Readiness. Medicaid Advisory Committee August 6, 2018 Angela Medrano, Deputy Director Kim Carter, Centennial Care Contract Bureau Chief. HSD Readiness Teams & Timeline. Teams : Medical Assistance Division – 31 s taff

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Centennial Care 2.0 MCO Readiness

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  1. Centennial Care 2.0 MCO Readiness Medicaid Advisory Committee August 6, 2018 Angela Medrano, Deputy Director Kim Carter, Centennial Care Contract Bureau Chief

  2. HSD Readiness Teams & Timeline Teams: • Medical Assistance Division – 31 staff • Behavioral Health Services Division – 3 staff • Office of Inspector General – 2 staff Timeline: • Desk Audits April – June 2018 • On-site Visits July – August 2018 • Open Enrollment October – December 2018 • Go-Live January 1, 2019

  3. Desk Audit Areas Operations Provider Network Program Integrity Quality Reporting Systems • Behavioral Health Services • Benefits • Care Coordination • Financial & Value Based Purchasing (VBP) • Long Term Services & Supports (LTSS) • Member Services

  4. MCO & HSD Roles for Desk Audits MCOs: • Provide Policies and Procedures • CC 2.0 specific • Detail to ensure compliance with Contractual Requirements HSD: • Review policies & Procedures • Approve or reject submission • Rejection includes specific feedback and due date for next submission

  5. On-Site Readiness Teams • Care Coordination • Finance and VBP • Systems • Member Services • Operations • Program Integrity • Provider Network • LTSS • Quality & UM

  6. Network Adequacy: MCO Requirements • Re-contract entire network for 2.0 • Establish and maintain a sufficient number of network providers capable of serving all members who enroll in their MCO. • Provide members with special health care needs direct access to a specialist, as appropriate for the members health care condition • Ensure that members have access to a 24/7 pharmacy in each geographic location where one is available

  7. Network AdequacyHSD Monitoring for Readiness • MCOs are required to submit a weekly update on Provider Contracting. • HSD provides a monthly provider enrollment roster to MCOs. • HSD provide MCOs with newly added or terminated providers on a daily basis. • HSD compares provider enrollment for each MCOs to the respective MCO provider contracting report to determine Provider contracting levels for each MCO. • Beginning August, 2018, MCOs will be required to submit a Geo Access Report in addition to the weekly Provider Contracting report. • Maps within the Geo Access report highlight gaps in provider contracting at the county level.

  8. Network Adequacy Readiness Determination • MCOs must demonstrate they have enough providers in each geographic region to meet member needs by October 2018. • If a MCO cannot demonstrate network adequacy in October they will be required to implement immediate corrective action. • If by December 2018, a MCO does not have a sufficient network in place, HSD will place a hold on member enrollment.

  9. Continued Monitoring Network Adequacy HSD monitors network adequacy and timely access to services in a variety of ways, including, but not limited to the following: • Geo Access Report • Network Adequacy Report • Appeals and Grievances Reports • External Quality Review Audits • MCO Call Center Reports • Provider and Member Satisfaction Surveys • Secret Shopper Surveys of providers conducted by HSD and MCOs

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