Medicaid Contract Purchasing Specifications
Data Collection and Reporting
Each of the child-related purchasing specifications contains
Contractor duties relating to collection and reporting of data, including
encounter data, utilization data, and adverse incidents reporting. It
is through data and information that purchasers, MCOs, and consumers are
able to measure performance on critical measures of access, utilization
and quality. In the absence of a reliable data and reporting system, both
the quality of a Contractor's performance, as well as a Contractor's accountability
for that performance, are difficult to ensure. The illustrative language
is drafted to capture data elements specific to the physical and behavioral
health services to be delivered to the population at issue.
|
Purchasing Specification
|
Related Contract Language
|
|
ACCESS
|
- §A2-10(a) (access
to pediatric preventive services)
|
|
CD
|
- §101(e)
(other contractor duties)
|
|
CW
|
- §110 (data
collection and reporting)
|
| CBHN |
Chapter I (prime/prime)‡
- §209 (data collection
and reporting)
Chapter II (prime/subprime)‡
- §108 (data collection
and reporting)
- §214 (data collection
and reporting)
|
| CSHCN |
- §208 (data collection
and reporting)
|
|
CC
|
- §107 (data collection
and reporting)
|
|
DENTAL
|
- §204 (data collection
and reporting)
|
| IMMUN |
- §009 (data collection
and reporting)
|
|
LEAD
|
- §009 (data collection
and reporting)
|
| MEDIPED |
- §008 (Contractor
duty)
- Part 9 (data collection and
reporting)
- §1104 (reporting
by VFC program providers)
|
| SBHC |
|
| SCHIP |
- §008 (Contractor
duty)
- Part 9 (data collection
and reporting)
|
‡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)
|
