Ohio integrated suggestions from seventeen Local community listening sessions and two public requests for facts when establishing its procurement eyesight for Medicaid managed care. 

Michigan’s model deal necessitates MCOs to agreement with at the very least one particular total-time Group health employee for every 5,000 beneficiaries to aid beneficiaries in navigating dental benefits, to aid built-in behavioral health care, and deal with social motorists of health.   

One of several knowledge components required to estimate MLR is non-claims Price tag information.  Non-claims expenses tend to be the MCO’s administrative costs and should involve expenditures connected with service provider contracting, utilization management, statements processing and income.  

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*Prize winners might be randomly picked from all individuals who report at least at the time weekly on the obstacle.

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In anticipation of your condition’s next Medicaid managed care procurement, Washington handed laws requiring the condition agency to undertake community adequacy standards for behavioral health companies and determine choices to reduce supplier administrative load, which could consist of limiting the volume of MCOs operating in a area.   

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One example is, a 2023 OIG report discovered that some Medicaid MCOs have superior charges of denials for prior authorizations—requests for MCO acceptance of a service ahead of it truly is carried out—and discovered point out actions to oversee and make sure the appropriateness of denials.