Managed Care is a health care delivery system organized to manage cost, utilization, and quality. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these …

Federal Managed Care regulations at 42 CFR 438 recognize four types of managed care entities: Managed Care Organizations (MCOs) Comprehensive benefit package; Payment is risk-based/capitation; Primary Care Case Management (PCCM) Primary care case managers contract with the state to furnish case management (location, coordination, and monitoring ...

operating managed care since 1996 through its comprehensive risk-based . managed care organization (MCOs) program, which serves certain children, pregnant women and nondually eligible adults with disabilities, and - covers acute, primary, and some specialty care services, and outpatient behavioral health.

Federal regulations at 42 C.F.R. §438.200 et seq. require all states contracting with a managed care organization (MCO) or prepaid inpatient health plan (PIHP) to have a written strategy for assessing and improving the quality of managed care services offered within the state. CMS refers to this as the State Quality Strategy.

Federal regulations at 42 CFR Part § 438.340 for Medicaid and included in separate CHIP regulations through a cross-reference at § 457.1240(e) lay the groundwork for the development and maintenance of a state managed care quality strategy to assess and improve the quality of managed care services offered within the state.

STAR Health managed care program. STAR Health is operated under the state plan by contract with a managed care organization. Children and youth in Foster Care Medicaid are mandatorily enrolled in this program; this is allowed by the fact that the Texas Department of Family and Protective Services serves as the conservator for these members

The Managed Care Quality (MCQ) Cycle As the dominant delivery system for Medicaid and the Children’s Health Insurance Program ( CHIP), managed care has enormous potential to improve health care quality and outcomes. State Medicaid and CHIP agencies that contract with managed care plans (MCPs) are responsible for improving managed care quality ...

Overview of Current Managed Care Programs . In July 2011, about two thirds of Medicaid beneficiaries were enrolled in at least one of six managed care programs. In 1999, the state began using managed care to provide Medicaid(BadgerCare. in Wisconsin) acute, primary, and behavioral health services to parents and children.

Managed Care in Michigan . This profile reflects state managed care program information as of August 2014, and only includes information on active federal operating authorities, and as such, the program start date may not reflect the earliest date that a program enrolled beneficiaries and provided services.

risk-based managed care program, referred to as Medicaid Managed Care, for most Medicaid beneficiaries. In contrast to the Kentucky Health Partnership program, which uses regional networks to deliver care, the Medicaid managed care program contracts with commercial managed care organizations (MCOs) to cover acute, primary, and specialty services,