Medicaid Contract Purchasing Specifications
Memorandum of Understanding with Other State Agencies
The child-related purchasing specifications contain provisions
that would require contracting MCOs (or BHOs) to coordinate with state
(or local) agencies other than the Purchaser that have responsibility
for furnishing services needed by enrolled children. The coordination
mechanism is a memorandum of understanding (MOU) between the MCO (or BHO)
and the state (or local) agency. The illustrative language specifies the
elements of the memorandum which include responsibility for furnishing
and payment of covered and uncovered services, coordination of treatment
plans, continuation of services upon disenrollment, disposition of court
orders, data sharing, designation of liaisons, and resolution of disputes.
For additional illustrative language on MOUs, see Optional Purchasing
Specifications: Memorandum of Understanding between Public Health Agencies
and Medicaid Managed Care Organizations (forthcoming), www.gwhealthpolicy.org/.
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Purchasing Specification
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Related Contract Language
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CD
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| CW |
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| CBHN |
Chapter I (prime/prime):‡
- §207(b) (Mental
Health and Substance Abuse Agency)
- §207(c) (Child
Welfare Agency)
Chapter II (prime/subprime):‡
- §212(b) (Mental
Health and Substance Abuse Agency)
- §212(c) (Child
Welfare Agency)
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| CSHCN |
- §206(b) (Title V
Program for Children with Special Health Care Needs)
- §206(c) (Mental Health
and Substance Abuse Agency)
- §206(d) (Education
Agency and Part C Lead Agency)
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LEAD
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- §007 (agreements with
state or local public health agencies)
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| MEDIPED |
- §013 (Contractor
duty)
- Part 7 (relationships with
other state and local agencies)
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| SCHIP |
- §013 (Contractor
duty)
- Part 7 (relationships
with other state and local agencies)
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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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