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A considerate procurement and contracting system can also enable align stakeholder, point out and MCO expectations before the deal starts off, assure readiness, and steer clear of later difficulties. Louisiana’s model deal contains comprehensive descriptions of each condition company and MCO duties through the readiness evaluate course of action when the condition is deciding whether or not the MCO is ready to begin running.
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Before the state starts off vetting MCOs, it will have to initial choose the number of MCOs and where by they can run. The geographic assistance location and range of MCOs that works best for your point out may well count on who is roofed by Medicaid managed care, differing wants of rural and urban counties, if the state prioritizes Competitors in between MCOs and also the capacity on the point out agency to oversee the number of contracted MCOs.
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States may also establish standing advisory or oversight committees that include stakeholders to make certain ongoing oversight of Medicaid managed care. Illinois designed the Medicaid Managed Care Oversight Fee To judge the performance of your state’s Medicaid managed care application. The Fee features Associates from the two the legislative and executive branches in addition to stakeholder Associates from vendors, MCOs, academia, and Medicaid shoppers and client advocates.
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Texas handed laws necessitating the point out Medicaid agency to publish contract enforcement actions taken in opposition to Medicaid MCOs on the point out Web site, which includes monetary penalties. MCOs could be to blame for fiscal penalties for failures to meet entry expectations, timely appointment expectations, timely adjudication of statements, quality overall performance specifications and a lot more.
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Location the stage prior to the agreement is signed through scoping, procurement, agreement conditions and level environment.
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