Medicaid Managed Care Regulations - Disability Rights California医疗护理管理规定残疾人权利的加利福尼亚.pptVIP

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Medicaid Managed Care Regulations - Disability Rights California医疗护理管理规定残疾人权利的加利福尼亚.ppt

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Medicaid Managed Care Regulations - Disability Rights California医疗护理管理规定残疾人权利的加利福尼亚

Medicaid Managed Care Regulations Silvia Rodriguez-Sánchez Erika Cristo Discussion Overview Background MMC Regulations Technical Areas DMH Implementation Process DMH Communication with CMS Beneficiary Problem Resolution Processes Title 9, CCR, §1850.205 Title 42, CFR, §438, Subpart F Background Medicaid is a joint Federal and State health care program States have flexibility in administering their Medicaid programs DHS administers California’s Medicaid program: Medi-Cal DMH administers California’s Medi-Cal Managed Mental Health Care Program Background, Cont. The Balanced Budget Act (BBA) of 1997 allowed States greater flexibility in administering their Medicaid programs CMS published the MMC Final Rule on June 14, 2002 to implement the provisions of the BBA The MMC regulations compliance due date was August 13, 2003 Background, Cont. County Mental Health Plans (MHPs) are considered Prepaid Inpatient Health Plans (PIHPs) MHPs must comply with MMC regulations that apply to PIHPs DMH must comply with MMC regulations as the administrator of the Medi-Cal managed mental health care program for California MMC Technical Areas Information Requirements Beneficiary Rights and Protections Emergency and Post-Stabilization Availability of Services Assurances of Adequate Capacity and Services Authorization of Services MMC Technical Areas, Cont. Provider Selection Practice Guidelines Quality Assessment and Performance Improvement Programs External Quality Reviews Health Information Systems Grievance and Appeals Systems Program Integrity Regulations Text The full text of the MMC regulations is available on the CMS website: /medicaid/managedcare/cms2104f.asp DMH Implementation Process Detailed analysis of proposed regulations Participation in CMS’ public comment period Waiver Requests Internal Workgroup DMH Implementation Process, Cont. California Mental Health Directors Association (CMHDA) Workgroup – Biweekly Meetings Client Family Member Task Force (CFMTF) Work