Promoting Access in Medicaid and CHIP Managed Care: A Toolkit for Ensuring Provider Network Adequacy and Service Availability

Promoting Access in Medicaid and CHIP Managed Care: A Toolkit for Ensuring Provider Network Adequacy and Service Availability

Published: Apr 30, 2017
Publisher: Baltimore, MD: Division of Managed Care Plans, Center for Medicaid and CHIP Services, CMS, U.S. Department of Health and Human Services
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Associated Project

Medicaid and CHIP Managed Care: Tools and Technical Assistance to Support Federal and State Oversight

Time frame: 2012-2023

Prepared for:

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Division of Managed Care Policy

Authors

Debra J. Lipson

Katharine Bradley

Corinne Lewis

Allison Wishon Siegwarth

In a project for the Centers for Medicare & Medicaid Services Center for Medicaid and CHIP Services, Mathematica developed a toolkit to assist states in developing their network adequacy and service availability standards for Medicaid and CHIP managed care organizations (MCOs). The toolkit is a compilation of effective and promising network adequacy and service availability strategies and analysis techniques, as well as valuable data sources that states are using to develop standards and monitor the availability of MCO network providers and services. It provides detailed descriptions of strategies and techniques that states can easily replicate, or customize, to measure access to primary care, behavioral health services, long-term services and supports, and other types of services in Medicaid and CHIP managed care programs.

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