Medicaid Contract Purchasing Specifications

Part 7 Relationships with Other State and Local Agencies¹

If, as a purchaser, you are interested in buying pediatric care for Medicaid-eligible children from managed care organizations on a risk basis, the following language on relationships with other agencies and programs is for your consideration. Purchasers may also find it useful to review Negotiating the New Health System (3^rd Ed.) which provides other options relating to relationships with other state and local agencies used by state agency purchasers in contracting with Medicaid MCOs at Table 4.1, Vol. 2, Part 3, pages 4-6 through 4-140 (www.gwu.edu/~chsrp).

Table of Contents

§701. In General
§702. Relationships with State and Local Public Health Agencies
§703. Relationship with State Title V Agency
§704. Relationship with State WIC Agency
§705. Relationship with State CHIP Agency
§706. Relationship with State and Local Education and Part C Lead Agencies
§707. Relationship with State Child Welfare Agency
§708. Relationship with State Developmental Disabilities Agency
§709. Relationship with State Mental Health and Substance Abuse Agency

If, as a purchaser, you are interested in purchasing pediatric care for Medicaid-eligible children from managed care organizations on a risk basis, the following language is for your consideration.

^K§701. In General²

Commentary: The state and local agencies referenced in this Part will generally not be parties to a contract between a State Medicaid Agency and an MCO. These agencies may, however, have formal legal relationships with the State Medicaid Agency that bear on the provision of health care services to Medicaid-eligible children. One option that a State Medicaid Agency may wish to explore is to impose a duty on the MCOs with which it contracts to cooperate with one or more of these other state and local agencies in achieving common program goals. Of course, these state and local agencies are under no legal duty to cooperate with contracting MCOs, and these sample purchasing specifications do not impose such an obligation.

(a) Relationships with Other State and Local Agencies — Contractor shall comply with the requirements of:

(1) §702 regarding relationships with State and Local Public Health Agencies;

(2) §703 regarding relationships with the State Title V Agency;

(3) §704 regarding relationships with the State WIC Agency;

(4) §705 regarding relationships with the State CHIP Agency;

(5) §706 regarding relationships with State and Local Education and Part C Lead Agencies;

(6) §707 regarding relationships with the State Child Welfare Agency;

(7) §708 regarding relationships with the State Developmental Disabilities Agency; and

(8) §709 regarding relationships with the State Mental Health and Substance Abuse Agency.³

(b) Exchange of Information with Other State and Local Agencies

(1) Liaison — Contractor shall designate individual(s) to act as a liaison with the agencies enumerated in subsection (a) and [drafter insert names of other public agencies or programs that provide health or other services to enrolled children] for the purpose of responding to requests for information enumerated in paragraph (2).

(2) Information to Requesting Agencies to Facilitate Qualification for Public Benefits

(A) If an agency enumerated in paragraph (1) requests individual medical information regarding an enrolled child, Contractor shall, without charge to [drafter insert name of the requesting agency] or to the enrolled child (or the child's family or caregiver), provide the requested information to the agency if the conditions of subparagraph (B) are met.

(B) The conditions of this subparagraph are:

(i) [drafter insert name of the requesting agency] is authorized in writing by the family or caregiver of an enrolled child (or in the case of an adolescent, the enrolled adolescent) to obtain individual medical information concerning the enrolled child or adolescent; and

(ii) the information requested is required in order for the child to apply for assistance or benefits under a public program.

(3) Information to Requesting Agencies on Access to Covered Items and Services — Contractor shall, upon request, provide information to the agencies enumerated in paragraph (1) regarding:

(A) the scope of items and services covered under Part 1 furnished by Contractor to an enrolled child under [drafter insert name of purchasing document];

(B) the identity of providers participating in Contractor's provider's network; and

(C) the manner in which the agency may on behalf of an enrolled child request the furnishing of items or services covered under Part 1 to the child, including medical evaluations or assessments necessary to enable the child to apply for benefits or assistance under a public program.

If, as a purchaser, you are interested in purchasing pediatric care for Medicaid-eligible children from managed care organizations on a risk basis, the following language on relationships with state and local public health agencies is for your consideration.

^K§702. Relationships with State and Local Public Health Agencies

(a) Reporting of Reportable Information —Contractor shall, consistent with the confidentiality requirements of subsection (c), promptly report to [drafter insert name of the appropriate state public health agency], in the form and manner required by such agency under [drafter insert reference to applicable state law], information regarding the incidence of the following reportable conditions or diseases:

(1) sexually transmitted diseases;

(2) tuberculosis;

(3) vaccine-preventable illnesses;

(4) metabolic or genetic conditions; and

(5) [drafter insert other conditions specified under state law].

(b) Cooperation with Case Surveillance and Prevention Responsibilities — Contractor shall, consistent with the confidentiality requirements of subsection (c), make available upon request to [drafter insert name of the appropriate state public health agency] individual medical information regarding an enrolled child that is necessary to enable the agency to carry out its responsibilities for surveillance and prevention of reportable diseases or disabling conditions under [drafter insert reference to state law].

(c) Confidentiality — In providing reportable information with respect to an enrolled child under subsection (a), or individual medical information with respect to an enrolled child under subsection (b), Contractor shall comply with the requirements relating to confidentiality enumerated in §1002 of Part 10.

(d) Implementation of Treatment Plan — In the case of an enrolled child with respect to whom [drafter insert name of state or local public health agency or agencies with jurisdiction] has issued a treatment plan with respect to [drafter insert names of relevant reportable diseases] under [drafter insert reference to applicable state law], Contractor shall:

(1) cover and furnish, or arrange for the furnishing of, the items and services that are specified in the treatment plan and are:

(A) enumerated under Part 1; and

(B) covered under §101A of Part 1A (relating to standards for medical necessity and coverage);⁴

(2) ensure that the enrolled child's primary care provider has:

(A) fully implemented the treatment plan; or

(B) on the basis of a medical evaluation of the child, undertaken an alternate treatment for the disease that is set forth in writing in the enrolled child's medical record; and

(3) notify the agency that issued the treatment plan, in such form and manner as the agency shall specify, of:

(A) Contractor's progress in implementing the treatment plan (or alternate treatment undertaken by the enrolled child's primary care provider); and

(B) the status of the enrolled child's disease.

(e) Memorandum of Understanding with State or Local Public Health Agency

(1) In General — Contractor shall enter into a memorandum of understanding with [drafter insert name of state or local public health agency with jurisdiction over Contractor's service area] that is willing to enter into such a memorandum, which shall have the same term as this [drafter insert name of purchasing document], and which shall address the matters enumerated in paragraph (2).

(2) Elements of Memorandum of Understanding — For illustrative language, see Sample Specifications for Memorandum of Understanding (CHSRP, forthcoming).

If, as a purchaser, you are interested in purchasing pediatric care for Medicaid-eligible children from managed care organizations on a risk basis, the following language on relationships with the State Title V agency is for your consideration.

^K§703. Relationship with State Title V Agency⁵

(a) Interagency Agreement — Contractor shall ensure that each provider participating in Contractor's provider network complies with [drafter insert the requirements, if any, applicable to Purchaser under its interagency agreement with the state Title V agency under §1902(a)(11)(B) of the Social Security Act, 42 U.S.C. §1396(a)(11)(B), and §505(a)(5)(F)(i) of the Social Security Act, 42 U.S.C. §705(a)(5)(F)(i), relating to coordination between Title V and Medicaid].

(b) Referral of Disenrolled Children — In the case of an enrolled child (including an adolescent) whose enrollment is terminated due to ineligibility for [drafter insert name of State Medicaid program], Contractor shall at the time of disenrollment notify the child and the child's family or caregiver in writing of the availability of health care services and care coordination from the [drafter insert name of State Title V Agency] or providers subcontracting with or funded by the agency.

Commentary: The following illustrative language enumerating elements for a memorandum of understanding between an MCO and a State Title V agency are consistent with elements required in the cooperative arrangements between State Medicaid Agencies and State Title V agencies under 42 C.F.R. §431.615(d). Note that federal Medicaid matching funds are available for payments to Title V grantees serving enrolled children under such arrangements,42 C.F.R. §431.615(e).

(1) In General — Contractor shall enter into a memorandum of understanding with [drafter insert name of State Title V Agency ] if the Agency is willing to enter into such a memorandum, which shall have the same term as this [drafter insert name of purchasing document], and which shall address the matters enumerated in paragraph (2).

(2) Elements of Memorandum of Understanding Relating to Delivery of Services

(A) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for the furnishing of, and payment for, items and services that:

(i) are covered under Part 1; and

(ii) the Agency routinely furnishes (or arranges through grantees or subcontractors for the furnishing of) to children;

(B) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for the furnishing of, and payment for, items and services that:

(i) are not covered under Part 1; and

(ii) the Agency routinely furnishes (or arranges through grantees or subcontractors for the furnishing of) to children;

(C) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for prompt identification of enrolled children with special health care needs (as defined in §1401(f)) or otherwise in need of medical or remedial services;

(D) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for arrangements for reciprocal referrals of enrolled children;

(E) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for exchange of data and information relating to items and services furnished to enrolled children; and

(F) The responsibility of Contractor and the responsibility of the Agency for the designation of individuals responsible for coordinating the implementation of the memorandum.

If, as a purchaser, you are interested in purchasing pediatric care for Medicaid-eligible children from managed care organizations on a risk basis, the following language on relationships with the State WIC agency is for your consideration.

^K§704. Relationship with State WIC Agency⁶

Commentary: Under federal law, state Medicaid agencies are required to coordinate the operation of the Medicaid program with the operation of WIC, §1902(a)(11)(C) of the Social Security Act, 42 U.S.C. §1396a(a)(11)(C). State Medicaid agencies are also required to ensure that all pregnant women, breastfeeding or post-partum women, or children under 5 who are eligible for Medicaid are notified of the availability of WIC benefits in a timely manner and referred to the State WIC agency, §1902(a)(53) of the Social Security Act, 42 U.S.C. §1396a(a)(53), 42 C.F.R. §431.635. The following illustrative language is designed to enable interested state Medicaid agencies to secure the assistance of contracting MCOs in the implementation of these statutory requirements. The language assumes that the state agency (or its enrollment broker) would provide the required notification at the time of eligibility determination, while referrals would be the responsibility of Contractors.

(a) Cooperation with WIC — Contractor shall ensure that each provider participating in Contractor's provider network cooperates with the [drafter insert names of State and local agencies through which services are provided to women, infants, and children under the WIC program under section 17 of the Child Nutrition Act of 1966, 42 U.S.C. §1786] in the implementation of the WIC program with respect to enrolled children who are enrolled in, or eligible for, the WIC program.

(b) Referral of Enrolled Children — Contractor shall comply the requirements of §005(h) of the Overview relating to referral of eligible or potentially eligible enrolled children in WIC.

(1) Duty to Refer — Contractor shall at the time of disenrollment notify an enrolled child described in paragraph (2) (and the child's family or caregiver) in writing of the availability of supplemental food, nutrition education services from the [drafter insert name of local WIC agency operating in area served by Contractor].

(2) Disenrolled Child — The duty described in paragraph (1) shall apply in the case of an enrolled child who has attained age 1 but has not attained age 5, or who is pregnant, postpartum, or breastfeeding, and whose enrollment is terminated due to ineligibility for [drafter insert name of State Medicaid program].

(d) Nutritional Risk — Contractor shall ensure that providers participating in Contractor's provider network respond in a timely manner to a request from [drafter insert name of local WIC agency] for the results of appropriate hematological tests, if any, performed with respect to an enrolled child that are necessary for the determination of whether the child is at nutritional risk (as defined in 7 C.F.R. §246.7(e)) for the purpose of establishing eligibility for WIC benefits.

(e) Memorandum of Understanding with State WIC Agency — Contractor shall enter into a memorandum of understanding with [drafter insert name of state WIC Agency] if the Agency is willing to enter into such a memorandum, which shall:

(1) have the same term as [drafter insert name of purchasing document]; and

(2) which shall facilitate Contractor's performance of its duties under subsection (c) with respect to the referral of enrolled children and disenrolled children to local WIC agencies.

If, as a purchaser, you are interested in purchasing pediatric care for Medicaid-eligible children from managed care organizations on a risk basis, the following language on relationships with the State CHIP agency is for your consideration.

^K§705. Relationship with State CHIP Agency

Commentary: The following illustrative language assumes that the state agency administering the State Children's Health Insurance Program (CHIP) under Title XXI of the Social Security Act is not the state Medicaid agency. If this assumption is incorrect, the language is inapplicable. If this assumption is correct, the language may be helpful regardless of whether the Contractor also participates in the CHIP program.

(a) Memorandum of Understanding with State CHIP Agency

(1) In General — Contractor shall enter into a memorandum of understanding with [drafter insert name of state agency administering the state child health plan under Title XXI] if the Agency is willing to enter into such a memorandum, which shall have the same term as [drafter insert name of purchasing document], and which shall address the matters enumerated in paragraph (2).

(2) Elements of Memorandum of Understanding Relating to Delivery of Services — The memorandum of understanding described in paragraph (1) shall enumerate the administrative and financial responsibilities of the Agency under state law and of Contractor under [drafter insert name of purchasing document] with respect to:

(A) a child entitled to benefits under [drafter insert name of State Medicaid program] who is enrolled in a plan operated by Contractor under [drafter insert name of purchasing document] and who loses eligibility for Medicaid benefits and establishes eligibility for coverage under [drafter insert name of State CHIP program];

(B) a child who loses eligibility for coverage under [drafter insert name of State CHIP program] and establishes eligibility for [drafter insert name of State Medicaid program];

(C) a child who loses eligibility for coverage under either [drafter insert name of State Medicaid program] or [drafter insert name of State CHIP program] and does not establish eligibility for either program; and

(D) [Drafter insert other issues identified by State CHIP Agency].

If, as a purchaser, you are interested in purchasing pediatric care for Medicaid-eligible children from managed care organizations on a risk basis, the following language on relationships with state and local education agencies and Part C lead agenies is for your consideration.

^K§706. Relationships with State and Local Education Agencies and Part C Lead Agency⁷

(a) Interagency Agreement — Contractor shall ensure that Contractor and each provider participating in Contractor's provider network complies with:

(1) [drafter insert the requirements, if any, applicable to Purchaser under its interagency agreement with the State Education Agency under Part B of the Individuals with Disabilities Education Act, 20 U.S.C. §1412(a)(12), 34 C.F.R. §300.142(b), (e), relating to furnishing or paying for services]; and

(2) [drafter insert the requirements, if any, applicable to Purchaser under its interagency agreement with the State Education Agency under Part C of the Individuals with Disabilities Education Act, 20 U.S.C. §1435(a)(10), relating to furnishing or paying for services].

(b) Memorandum of Understanding with State Education Agency or Part C Lead Agency

(1) In General — Contractor shall enter into a memorandum of understanding with [drafter insert name of State Education Agency or Part C Lead Agency] if the Agency is willing to enter into such a memorandum, which shall have the same term as this [drafter insert name of purchasing document], and which shall address the matters enumerated in paragraph (2).

(2) Elements of Memorandum of Understanding

(A) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for the furnishing of, and the payment for, items and services that:

(i) are covered under Part 1 with respect to enrolled children under IEPs (as defined in §1401(o)) or under IFSPs (as defined in §1401(p)); and

(ii) the Agency routinely furnishes (or arranges through grantees or subcontractors for the furnishing of) to children under IEPs or IFSPs;

(B) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for the furnishing of, and the payment for, items and services that:

(i) are not covered under §105 of Part 1 with respect to enrolled children under IEPs (as defined in §1401(o)) or under IFSPs (as defined in §1401(p)); and

(ii) the Agency routinely furnishes (or arranges through grantees or subcontractors for the furnishing of) to children with IEPs or IFSPs;

(C) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for payment for treatment of a member of the family of an enrolled child under an IEP or and IFSP, or a caregiver of the child, who is not enrolled under [drafter insert name of purchasing agreement], but who requires treatment in order to effectively treat a condition or developmental disability or delay of the child;

(D) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for the identification of enrolled children who may require an IEP or an IFSP;

(E) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors)

for arrangements for reciprocal referrals of enrolled children with IEPs or IFSPs;

(F) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for the exchange of data and information relating to items and services furnished to enrolled children with IEPs and IFSPs; and

(G) The responsibility of Contractor and the responsibility of the Agency for the designation of individuals responsible for coordinating the implementation of the memorandum.

If, as a purchaser, you are interested in purchasing pediatric care for Medicaid-eligible children from managed care organizations on a risk basis, the following language on relationships with the State child welfare agency is for your consideration.

^K§707. Relationship with State Child Welfare Agency

(a) Memorandum of Understanding with State Child Welfare Agency

(1) In General — Contractor shall enter into a memorandum of understanding with [drafter insert name of State Child Welfare Agency] if the Agency is willing to enter into such a memorandum, which shall have the same term as [drafter insert name of purchasing document], and which shall address the matters enumerated in paragraph (2).

(A) consistent with §202 of Part 2, the initial assessment of, and furnishing of items and services covered under Part 1 to, a newly enrolled child under the jurisdiction of the Agency;

(B) consistent with §202 of Part 2, the furnishing of or the referral for, items and services required by an enrolled child under the jurisdiction of the Agency that are not covered under Part 1;

(C) consistent with §907 of Part 9, the collection and reporting of encounter data regarding the furnishing of items and services covered under Part 1 to enrolled children under the jurisdiction of the Agency;

(D) consistent with §§204 and 205 of Part 2, the continuity of the furnishing of needed items and services upon the disenrollment of a child under the jurisdiction of the Agency; and

(E) [drafter insert other issues identified by State Child Welfare Agency].

If, as a purchaser, you are interested in purchasing pediatric care for Medicaid-eligible children from managed care organizations on a risk basis, the following language on relationships with the State developmental disabilities agency is for your consideration.

^K§708. Relationship with State Developmental Disabilities Agency

(a) Referral of Disenrolled Children — In the case of an enrolled child with a disability whose enrollment is terminated due to ineligibility for [drafter insert name of State Medicaid Program], Contractor shall at the time of disenrollment notify the child and the child's family or caregiver in writing of the availability of health care services and care coordination services from:

(1) [drafter insert name of state developmental disabilities agency]; or

(2) providers subcontracting with or funded by [drafter insert name of state developmental disabilities agency].

(b) Memorandum of Understanding with State Developmental Disabilities Agency

(1) In General — Contractor shall enter into a memorandum of understanding with [drafter insert name of state developmental disabilities agency] if the Agency is willing to enter into such a memorandum, which shall have the same term as this [drafter insert name of purchasing document], and which shall address the matters enumerated in paragraph (2).

(2) Elements of Memorandum of Understanding

(A) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for the furnishing of, and the payment for, items and services that:

(i) are covered under Part 1; and

(ii) the Agency routinely furnishes (or arranges through grantees or subcontractors for the furnishing of) to enrolled children;

(B) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for the furnishing of, and the payment for, items and services that:

(i) are not covered under §105 of Part 1; and

(ii) the Agency routinely furnishes (or arranges through grantees or subcontractors for the furnishing of) to enrolled children;

(C) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for payment for treatment of a member of the family of an enrolled child with special health care needs, or a caregiver of the child, who is not enrolled under [drafter insert name of purchasing agreement], but who requires treatment in order to effectively treat a condition or developmental disability or delay of the child;

(D) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for the identification of enrolled children with special health care needs;

(E) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for the arrangements for reciprocal referrals of enrolled children with special health care needs;

(G) The responsibility of Contractor and the responsibility of the Agency for the designation of individuals responsible for coordinating the implementation of the memorandum.

If, as a purchaser, you are interested in purchasing pediatric care for Medicaid-eligible children from managed care organizations on a risk basis, the following language on the relationships with the State mental health and substance abuse agency is for your consideration.

^K§709. Relationship with State Mental Health and Substance Abuse Agency

(a) Referral of Disenrolled Children — In the case of an enrolled child with special health care needs (as defined in §1401(f)) whose enrollment is terminated due to ineligibility, Contractor shall at the time of disenrollment notify the child and the child's family or caregiver in writing of the availability of behavioral health services and care coordination services from:

(1) [drafter insert name of State Mental Health and Substance Abuse Agency]; or

(2) providers subcontracting with or funded by [drafter insert name of State Mental Health and Substance Abuse Agency].

(b) Memorandum of Understanding with State Mental Health and Substance Abuse Agency

(1) In General — Contractor shall enter into a memorandum of understanding with [drafter insert name of State Mental Health and Substance Abuse Agency ] if the Agency is willing to enter into such a memorandum, which shall have the same term as this [drafter insert name of purchasing document], and which shall address the matters enumerated in paragraph (2).

(2) Elements of Memorandum of Understanding

(A) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for the furnishing of, and the payment for, items and services that:

(i) are covered under Part 1 with respect to enrolled children with special health care needs (as defined in §1401(f)); and

(ii) the Agency routinely furnishes (or arranges through grantees or subcontractors for the furnishing of) to children with special health care needs;

(B) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for the furnishing of, and the payment for, items and services that:

(i) are not covered under §105 of Part 1 with respect to enrolled children with special health care needs (as defined in §1401(f)); and

(ii) the Agency routinely furnishes (or arranges through grantees or subcontractors for the furnishing of) to children with special health care needs;

(C) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for payment for treatment of a member of the family of an enrolled child with special health care needs, or a caregiver of the child, who is not enrolled under [drafter insert name of purchasing agreement], but who requires treatment in order to effectively treat a condition or developmental disability or delay of the child;

(D) The responsibility of Contractor and the responsibility of the Agency (or the Agency's grantees or subcontractors) for the identification of enrolled children with special health care needs;

(F) The responsibility of Contractor and the responsibility of the Agency for the exchange of data and information relating to items and services furnished to enrolled children with special health care needs; and

(G) The responsibility of Contractor and the responsibility of the Agency for the designation of individuals responsible for coordinating the implementation of the memorandum.

^KCompliance measure: Contractor shall make available to Purchaser on request copies of memoranda of understanding executed with the various state and local agencies under this Part.

Endnotes

See also CHSRP, Sample Purchasing Specifications: Memoranda of Understanding Between Managed Care Organizations and Public Health Agencies (forthcoming).
See also "Public Health and Managed Care Opportunities for Collaboration," a July 1999 report by the Office of Inspector General, DHHS, to assess how State public health agencies are taking advantage of opportunities for collaboration with managed care plans to further population-based activities (www.dhhs.gov/progorg/oei).
An alternative option would be to delete one or more of the paragraphs (1) through (8). The result would be to limit Contractor's duties with respect to state and local agencies to those duties that are specified in the retained paragraphs. Relationships, if any, with the deleted agencies would be determined outside the context of the purchasing agreement.
In addressing the issue of who determines the medical necessity of services covered under a treatment plan for reportable diseases, purchasers may wish to consider who is authorized to make a medical necessity determination. For example, a number of state Medicaid programs specify that in the case of diseases that present a public health threat (e.g., tuberculosis, certain sexually transmitted diseases), decisions made by a public health agency regarding the continued need for treatment shall be binding on contractors. Where treatment of certain public health diseases can be compelled under state law, state law may also require that treatment continue until completed in accordance with a decision of the appropriate public health official. In such a situation, a purchaser may wish to ensure that its contractors adjust their coverage standards to comply with public health determinations. Otherwise, in the case of Medicaid agencies, the agency itself may remain liable for the treatment as a non-contract, but medically necessary, service. Alternatively, the state public health agency may be obligated to pay for the treatment as an uninsured service. In states in which Medicaid already pays for mandated public health treatments, the cost of such services should already be in contractor's premium base, unless explicitly carved out.
For additional specifications relating to interagency agreements, see Association of Maternal and Child Health Programs, State MCH-Medicaid Coordination: A Review of Title V and Title XIX Interagency Agreements, December 1992 (available from National Center for Education in Maternal and Child Health, www.ncemch01@gumedlib.dml.georgetown.edu).
For additional information relating to coordination of WIC and Title V, see Association of Maternal and Child Health Programs, MCH Related Federal Programs: Legal Handbooks for Program Planners —The Special Supplemental Food Program for Women, Infants, and Children, November 1991 (available from National Center for Education in Maternal and Child Health, www.ncemch01@gumedlib.dml.georgetown.edu).
In a May 21, 1999 Letter to State Medicaid Directors, HCFA reaffirms that "Medicaid is the payer of first resort for medical services provided to children with disabilities pursuant to the Individuals with Disabilities Education Act (IDEA)." The Letter also sets forth guidance to state Medicaid agencies relating to Medicaid payment for transporting eligible IDEA children to and from school. www.hcfa.gov/medicaid/smd52199.htm.

Medicaid Contract Purchasing Specifications

Part 7

Relationships with Other State and Local Agencies1

Relationships with Other State and Local Agencies¹