CMS Issues Toolkit on Managed Care Access
The Centers for Medicare and Medicaid Services (CMS) has issued a Toolkit titled “Promoting Access in Medicaid and CHIP Managed Care.” The toolkit outlines effective strategies and promising practices for ensuring Managed Care Organization (MCO) network adequacy and access to services. Notably, the report includes a section discussing network adequacy and access for Managed Long Term Supports and Services (MLTSS) plans.
The toolkit drew from multiple data sources and methods, including the following:
- A review of published and grey literature, to understand the range of state approaches to developing and monitoring provider network and access standards, examine evidence on the impact of state standards and monitoring practices on access and service use, and identify standard metrics for monitoring and evaluating access;
- An assessment of relevant national and state-level data on Medicaid beneficiary health needs, utilization trends, and provider supply;
- A review and analysis of state Medicaid contracts, managed care quality strategies, and external quality review reports to identify model contract language, access goals, and strategies that promote network adequacy and service availability.
The toolkit also describes many practices that state representatives discussed when they participated between July and November 2016 in a series of conference calls organized CMS, the National Association of Medicaid Directors (NAMD), and Mathematica Policy Research.
The section on MLTSS discusses time and distance standards for certain LTSS providers where beneficiaries must travel to the site of care, as well as strategies for addressing availability of care when providers deliver services in the participant's home. The report also looks at state policies to promote continuity of care upon the enactment of MLTSS pro