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Changes Recommended for Medicaid Managed Care

June 30, 2015

U.S. Department of Health and Human Services has released draft rules on network adequacy for privatized Medicaid, also known as managed care. The network adequacy guidance include quality ratings, profit guidelines, and safeguards to protect members with disabilities or limited English proficiency. These safeguards include language that requires “meaningful access” to grievance and appeals information for people with disabilities and people with limited English proficiency.

In that vein, the regulations require states to provide information on network adequacy to people with disabilities in accessible and alternative formats in order to promote meaningful access and assure strong informed choice. Similarly, the regulations require providers to make enrollee handbooks available in accessible and alternative formats at no cost in addition to ensuring that members who use augmentative and alternative communication (AAC) devices are able to understand the enrollment process and implications. The regulations also require managed care long-term services and supports providers to have accessible office spaces, websites, and equipment to maximize access for all members or potential members with disabilities.

Most importantly, the proposed rule addresses provisions for coordination and continuity of care to ensure that people with disabilities relying on coordination of multiple types of services and care are able to receive high-quality services through a managed care organization. In particular, these provisions address those for whom complex service coordination is necessary to enable living in the community, maintaining employment, or participating in other social and recreational activities in settings of their own choosing.