Providing High-Quality Services to Children with Special Health Care Needs (CSHCN) Under Managed Care

Structuring Contracts

Ensuring High-Quality Care for Children with Special Health Care Needs

The quality of care provided to CSHCN under any type of managed care arrangement will ultimately depend on the State's ability to enforce its policies through contracts with managed care plans.

Elizabeth Wehr, J.D., a Research Scientist for the Center for Health Policy Research at The George Washington University Medical Center, discussed her recent national research on State Medicaid managed care contracts.

The purposes of the study were to establish a baseline to understand what services States are asking Medicaid managed care plans to provide and to create a resource for States on the contracting activities of other States. She said that the study found that there are several general contracting principles that States need to remember, which are to:

• Consider the role of contracts is in a deregulated health system.
• Craft enforceable language (with no omissions or ambiguities).
• Read the document from the point of view of the other party.
• Remember the role of subcontractors in delivering managed care services.

In addition, Ms. Wehr described the major domains of Medicaid managed care contracts as benefit coverage, the service system and plan practices, the plans' relationship to the larger health care system, and the business relationship with plans. She also provided examples of specific Medicaid managed care contract language to show how this language must be carefully written to ensure that high-quality care is provided by the plans.

References

Wehr E. Medicaid Contracting for Managed Care Services for Children with Special Health Care Needs. Center for Health Policy Research. The George Washington University Medical Center:1-7.

Rosenbaum S. "A Look Inside Medicaid Managed Care." Health Affairs July/Aug. 1997;16(4):266-71.

Wehr, Elizabeth. Major Domains of Medicaid Managed Care Contracts. Center for Health Policy Research. The George Washington University Medical Center.

Current as of September 1997

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Internet Citation:

Providing High-Quality Services to Children with Special Health Care Needs Under Managed Care. Workshop Summary, September 10-12, 1997. User Liaison Program, Agency for Health Care Policy and Research, Rockville, MD. http://www.ahrq.gov/news/ulp/ulpchld1.htm