Medicaid Contract Purchasing Specifications
Family Participation in Service Provision
Many of the child-related purchasing specifications contain
provisions relating to the participation by enrolled children and their
families in the planning and provision of services. The illustrative provisions
address family participation in the following activities: the assessment
of an enrolled child's treatment needs; the selection of an enrolled child's
primary care provider or pediatric specialist; the development, implementation,
and monitoring of an enrolled child's treatment plan (if any); and the
use of the MCO's (or BHO's) grievance procedures by an enrolled child
and his or her family.
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Purchasing Specification
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Related Contract Language
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CD
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- §101(c)(family participation
requirements)
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CW
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- §103 (assessment)
- §104(c)
(development of case management plan)
- §105 (assignment
to primary care provider
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CBHN
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Chapter I (prime/prime):‡
- §101(d) (family participation
requirements)
Chapter II (prime/subprime):‡
- §101(e) (family participation
requirements)
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CSHCN
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- §101(d) (family participation
requirements)
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| MEDIPED |
- Part 4 (family participation
in provider selection and assignment)
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SCHIP
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- Part 4 (family participation
in provider selection and assignment)
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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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