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DHHS details new Medicaid care‑management contract features; ties payments to primary care, polypharmacy review and community behavioral health funding
Summary
State officials described the Medicaid Care Management 3 procurement and accompanying quality strategy on April 25, saying the contract shifts more payment to providers for prevention and care coordination, expands polypharmacy medication reviews, creates a shared high‑cost drug risk pool, and directs additional funding to community mental health
Department of Health and Human Services officials presented the newly procured Medicaid care‑management contract and associated quality strategy to the House Health and Human Services Oversight Committee on April 25, outlining changes intended to strengthen primary care, behavioral health integration and medication management.
Henry Littman, who led the procurement overview, said the new contract (referred to as MCM‑3) begins Sept. 1 and moves more funds toward providers to create “authentic patient relationships” and reimburse primary care teams for prevention, care coordination and medication management activities. “A lot of it is in primary care and prevention,” Littman said, adding that shifting dollars closer to providers aims to reduce hospitalizations and long‑term costs.
The nut graf: The procurement ties quality and payment through several levers: a mandatory quality withhold (2% of capitation) that MCOs can earn back by meeting CMS Core Set and HEDIS…
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