The Influence of National Standards on Medicaid Managed Care Programs: Implications for Children and Youth with Special Health Care Needs.

Publisher: Kluwer Academic/Plenum Publishers Country of Publication: United States NLM ID: 9715672 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1573-6628 (Electronic) Linking ISSN: 10927875 NLM ISO Abbreviation: Matern Child Health J Subsets: MEDLINE

Publication: 1999- : New York, NY : Kluwer Academic/Plenum Publishers
Original Publication: New York : Plenum Press, c1997-

Managed Care Programs* ; Medicaid*; Accountable Care Organizations ; Adolescent ; Adult ; Child ; Colorado ; Florida ; Health Facilities ; Humans ; Standard of Care ; United States

Introduction: To improve services and assure predictable costs of care for Children and Youth with Special Health Care Needs (CYSHCN), state Title V and Medicaid programs are cooperating to reconceive care systems including contracting arrangements with managed care organizations (MCOs). This article describes how a consensus-based framework, the National Standards for Systems of Care for CYSHCN, influenced the redesign of two state Medicaid managed care programs: a statewide managed care plan for children with medical complexity in Florida and a regional accountable care program serving children and adults in Colorado.
Methods: Data are drawn from a recent evaluation of the National Standards, which define the core components of a comprehensive, coordinated, and family-centered system of care for CYSHCN. The authors synthesized insights from documents and semi-structured interviews with national and state stakeholders.
Results: The states used the National Standards in different ways. Florida translated the Standards into contract provisions and holds its MCO accountable to performance targets specific to CYSHCN. In Colorado, the Standards had an indirect influence on contract provisions with regional accountable entities (RAEs) and the state's oversight of EPSDT, which helps ensure that RAEs meet their obligations to CYSHCN. Managed care leaders viewed the Standards as an impetus to sharpen quality improvement and foster whole-person care.
Discussion: The National Standards offer a flexible framework to help states design Medicaid managed care programs and improve systems of care for CYSHCN. States can learn from one another's experiences applying the Standards in the context of their policy environments.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

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#2019-02066 Lucile Packard Foundation for Children's Health

Keywords: Accountable care; CYSHCN; Managed care; Medicaid; Standards of care

Date Created: 20220823 Date Completed: 20220923 Latest Revision: 20221003

20250114

10.1007/s10995-022-03499-y

35999481