Medicaid Contract Purchasing Specifications
Benefits and Service Duties
Each of the purchasing specifications relating to children contains language
framing a benefit package appropriate to the subpopulation of children
at issue. Common to all of these specifications other than SCHIP Pediatric
Services (SCHIP) is Medicaid's Early and Periodic Screening, Diagnostic,
and Treatment (EPSDT) services benefit. For a more detailed listing of
EPSDT-related provisions in the purchasing specifications, see EPSDT,
below.
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Purchasing Specification
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Related Contract Language
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ACCESS
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- Part A3 (services
promoting access)
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CD
|
- §101(a)
(scope)
- §102 (screening)
- §103 (developmental
health promotion services)
- §104 (general
developmental interventions)
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|
CW
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- (see CBHN purchasing specifications below)
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|
CBHN
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Chapter I (prime/prime):‡
- §102 (scope
of benefit)
- §103 (mental health
services)
- §104 (substance abuse
services)
- §106 (prescription
drugs)
Chapter II (prime/subprime):‡
- §103 (scope of benefit)
- §203 (mental
health services)
- §204 (substance
abuse services)
- §206 (prescription
drugs)
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CSHCN
|
|
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CC
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- §103 (oral interpreter
services)
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DENTAL
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- §102 (scope of benefit)
- §103 (preventive
services)
- §104 (treatment
and restorative services)
- §105 (radiographic,
lab, and other diagnostic services)
- §106 (prescription
drugs)
|
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IMMUN
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- §003 (immunization-related
services)
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LEAD
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- §003 (lead-related services)
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MEDIPED
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- §002 (services)
- Part 1 (items and services)
- Part 1B (delivery of covered
items and services)
|
|
SBHC
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- §101A(b) (items and
services subject to payment)
- §101B(b) (items
and services subject to payment)
- §102C(d) (items
and services subject to payment)
- §104C(e) (items and
services subject to payment)
|
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SCHIP
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- §002 (services)
- Part 1 (items and
services)
- Part 1B (delivery
of covered items and services)
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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)
-
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)
-
SBHC = School-Based Health
Center Services (January 2002)
-
SCHIP = SCHIP Pediatric
Services (April 2002)
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