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DMS outlines managed-care oversight, value-based purchasing and service-cap safeguards
Summary
Agency officials told the committee they use contract monitoring, value-based purchasing with a 2% withhold and reporting (including HEDIS) to track MCO performance; they also described EPSDT protections for children and procedures to request exceptions to therapy visit caps for adults.
The Department for Medicaid Services told the Health Budget Review Subcommittee the agency monitors managed-care organizations (MCOs) through contract reporting, external quality review and a recently implemented value-based purchasing arrangement.
Commissioner Lisa Lee said DMS implemented a value-based purchasing agreement in which the department withholds 2% of MCO capitation payments until contracted quality measures are met. "We have implemented this year a value based purchasing agreement with our managed care organizations whereby we have a 2% withhold of their capitation payment,"…
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