Medicaid Managed Care – Individualized Technical Assistance for States
Direct technical assistance is available from the Centers for Medicare & Medicaid Services (CMS) to assist state Medicaid agencies in developing, enhancing, implementing, and evaluating managed care programs.
Technical assistance is provided by CMS through Mathematica Policy Research, the Center for Health Care Strategies, Manatt Health Solutions, National Committee for Quality Assurance, and Arden Health Advisors. Examples of areas where states may request direct technical support include:
Managed Care Program Planning & Procurement
- Federal managed care authorities and waiver applications
- Rate setting and risk adjustment
- Managed care organization (MCO) contracting and purchasing
- Stakeholder engagement
Access, Quality and MCO Financial Monitoring and Oversight
- Developing standards and measuring provider network adequacy
- Quality measurement, reporting, and improvement
- MCO financial oversight
- Monitoring and enforcing MCO compliance with contract provisions
- Ensuring program integrity and preventing fraud and abuse in MCOs
Benefit Design & Specialized Services and Populations
- Behavioral health services
- Behavioral and physical health integration
- Dual eligibles and managed care
- Managed long term services and supports
- Other, i.e. dental, transportation, pharmacy
Beneficiary Enrollment, Education, and Rights
- Beneficiary education/information
- Contracting with enrollment brokers
- Developing and implementing auto-enrollment/auto-assignment strategies
- Managing grievances and appeals
Data
- Analyzing data for performance measurement
- Developing or implementing information technology and systems
- Encounter data collection and validation
To request technical assistance, states should submit the following form: