Medicaid Contract Purchasing Specifications
Quality Improvement and Performance Measurement
Most of the pediatric purchasing specifications contain provisions relating
to quality improvement and measurement. These provisions incorporate a
number of approaches to quality improvement and measurement from which
purchasers and MCOs interested in improving the quality of care available
to enrolled children may select. These approaches include clinical studies
on specific conditions, drug formulary assessments, external quality review,
focus studies, and enrollee satisfaction surveys.
| Purchasing
Specification |
Related
Contract Language |
| ACCESS |
- §A2-11 (focus studies
on access)
|
| CD |
|
| CBHN |
Chapter I (prime/prime):‡
- §208 (quality measurement
and improvement)
Chapter II (prime/subprime):‡
- §107 (quality measurement
and improvement)
- §213 (subcontractor
compliance)
|
| CSHCN |
- §207 (quality measurement
and improvement)
|
| CC |
- §106 (quality measurement
and improvement)
|
| DENTAL |
- §205 (quality measurement
and improvement)
|
| IMMUN |
- §008 (quality measurement
and improvement)
|
| LEAD |
- §008 (quality measurement
and improvement)
|
| MEDIPED |
- §007 (Contractor
duty)
- §802 (quality measurement
and improvement program)
- §803 (clinical studies)
- §804 (drug formulary
assessment)
- §805 (utilization
review)
- §806 (external quality
review)
- §807 (periodic medical
audits)
|
| SCHIP |
- §007 (Contractor
duty)
- §802 (quality
measurement and improvement program)
- §803 (clinical
studies)
- §804 (drug formulary
assessment)
- §805 (utilization
review)
|
‡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)
|
