Medicaid Contract Purchasing Specifications

Assessment and Identification of Enrolled Children

Another Contractor duty common to many of the purchasing specifications is the identification of enrolled children with special needs, whether developmental, behavioral, or other. Linked to this duty is the duty to assess the children so identified to determine precisely what services they require. The identification and assessment of children with special needs is necessary to trigger service duties on the part of the contracting MCO that it does not have toward other enrolled children without special needs, such as a requirement to furnish case management services. The illustrative language found in the following provisions reflects approaches specific to the subpopulation of children addressed.

Purchasing Specification	Related Contract Language
ACCESS	§A2-8 (first appointments for new enrollees)
CD	§102(a) (developmental screen) §102(b) (family psychosocial screen) §103(b) (behavioral assessment to assist parents)
CW	§102 (identification) §103 (initial screening and comprehensive health assessment)
CBHN	Chapter I (prime/prime):‡ §103(a) (assessment, diagnosis, and related services) Chapter II (prime/subprime):‡ §102 (identification) §203(a) (assessment)
CSHCN	§102 (identification) §105(b) (development of care plan)
CC	§103 (identification and self-identification of enrollees with limited English proficiency)
DENTAL	§103 (preventive services)
IMMUN	§003(b) (screening services)
LEAD	§003(b) (screening services)
MEDIPED	§601(b) (initial assessment)
SCHIP	§601(b)(2) (initial assessment)

‡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.

ACCESS = Access to Services (July 2000)
CD = Child Development Services (July 2000)
CW = Child Welfare (December 2001)
CBHN = Children with Behavioral Health Needs (December 2000)
CSHCN = Children with Special Health Care Needs (August 2000)
CC = Cultural Competence (Updated, November 2001)
DENTAL = Dental and Oral Pediatric Health Services (March 2000)
IMMUN = Immunizations (May 1998)
LEAD = Childhood Lead Poisoning Services (November 1998)
MEDIPED = Medicaid Pediatric Services (September 1999)
SBHC = School-Based Health Center Services (January 2002)
SCHIP = SCHIP Pediatric Services (April 2002)