Medicaid Contract Purchasing Specifications
Treatment Plans
A number of the pediatric purchasing specifications contain requirements
for Contractors relating to the development and implementation of plans
to manage the care of enrolled children with specialized needs. (For provisions
relating to the identification of these enrolled children and the assessment
of their needs, see Assessment and Identification
above). The specifications include a range of plans reflecting the diversity
of the subpopulations of children involved, including case management
plans, individual care plans, and inpatient discharge plans. In each case,
the illustrative language specifies the procedures for developing the
plans (including the involvement of enrolled children and their families),
the content of the plans, and coordination of the plans with other plans
(such as IEPs or IFSPs).
Purchasing Specification |
Related Contract Language |
| ACCESS |
- §A3-2(a) (duties
to enrollees with treatment plans)
|
| CW |
|
| CBHN |
Chapter 1 (prime/prime):‡
- §105A (treatment plan)
- §105B (inpatient discharge
plan)
Chapter II (prime/subprime):‡
- §205A (treatment
plan)
- §205B (inpatient
discharge plan)
|
| CSHCN |
|
| LEAD |
|
‡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)
|
