Medicaid Contract Purchasing Specifications
Adolescent Health
Two of the purchasing specifications -- Medicaid Pediatric Services (MEDIPED)
and SCHIP Pediatric Services (SCHIP) -- contain numerous provisions relating
to adolescent health. These provisions have been compiled in two User
Guides, one for each set of specifications, which are referenced in the
following table and are posted on CHSRP's website, www.gwhealthpolicy.org.
The remaining purchasing specifications contain selected provisions relating
to adolescent health, including selection of providers, confidentiality,
and preventive services, that are set forth below. For illustrative language
relating to reproductive health issues affecting adolescents, see §201(b)
of Sample Purchasing Specifications for Reproductive Health (May
2000), www.gwhealthpolicy.org.
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Purchasing Specification
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Related Contract Language
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ACCESS
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- §A1-3(a) (access
to pediatric preventive services)
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CBHN |
Chapter I (prime/prime)‡
- §105 (case management)
- §105A (treatment plan)
- §204 (multidisciplinary
team)
- §210(e) (confidentiality)
Chapter II (prime/subprime)‡
- §109(e) (confidentiality)
- §205 (case management)
- §205A (treatment
plan)
- §209 (multidisciplinary
team)
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CSHCN |
- §104 (care coordination
services)
- §105 (care plan)
- §203 (provider selection
and assignment)
- §209(d) (confidentiality)
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IMMUN |
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MEDIPED |
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SBHC |
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SCHIP |
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‡The "prime/prime" arrangement has two primary contractors—the
MCO and the BHO—to which the state purchaser makes capitation payments.
Under this arrangement, a child is enrolled in both the MCO and the BHO.
The "prime/subprime" arrangement involves one primary contractor
and a subcontractor. The state purchaser contracts with and makes capitation
payments to an MCO; the MCO, in turn, subcontracts with the BHO for the
provision of behavioral health services.
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ACCESS = Access to
Services (July 2000)
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CD = Child Development
Services (July 2000)
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CW = Child Welfare
(December 2001)
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CBHN = Children with
Behavioral Health Needs (December 2000)
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CSHCN = Children with
Special Health Care Needs (August 2000)
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CC = Cultural Competence
(Updated, November 2001)
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DENTAL = Dental and
Oral Pediatric Health Services (March 2000)
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IMMUN = Immunizations
(May 1998)
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LEAD = Childhood Lead
Poisoning Services (November 1998)
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MEDIPED = Medicaid Pediatric
Services (September 1999)
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SBHC = School-Based Health
Center Services (January 2002)
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SCHIP = SCHIP Pediatric
Services (April 2002)
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