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August 14, 2015
Managed Care in California Series, Issue 4: Internal Grievances and External Review
Abbi Coursolle Issue Brief
Federal and state law and the state and federal constitutions require that beneficiaries in Medi-Cal managed care plans receive notice, and grievance and appeal rights when they are denied access to medically necessary services. Frequently, however, enrollees fail to receive the required notice, get an inadequate notice, or do…
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August 14, 2015
Managed Care in California Series, Issue 5: Internal Grievances and External Review for Service Denials in Covered California Plans
Abbi Coursolle Issue Brief
Federal and state law and the Constitution ensure that enrollees in publicly-funded health care plans receive notice, grievance and appeal rights when they are denied access to medical services. Enrollees in Covered California plans have the right to a notice when their plan denies access to a service, and…
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August 12, 2015
Health Advocate: Essential Health Benefits Overview
Michelle Lilienfeld Issue Brief
Introduced by the Affordable Care Act, Essential Health Benefits (EHB) are a set of ten health care service categories that certain health plans must cover. In February 2015, HHS issued a Final Rule, which finalized changes to the EHB standard. This month's Health Advocate offers an EHB overview in…
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August 11, 2015
Model Medicaid Managed Care Contract Provisions: EPSDT Vision and Hearing Services
Jane Perkins, Sarah Somers, and External Source Issue Brief
Children enrolled in Medicaid are entitled to a comprehensive array of preventive and ameliorative care through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. As states have increasingly turned to managed care entities to fulfill their Medicaid administrative obligations, these companies are charged with affirmative duties to…
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August 5, 2015
State Medicaid Eligibility Policies for Individuals Moving Into and Out of Incarceration
Catherine McKee Issue Brief
Connecting individuals moving into and out of incarceration to health coverage may not only increase their access to care and improve their health status, but may also lead to state savings. Based on a review of state statutes, regulations, publicly available state Medicaid policies, and Medicaid managed care contracts,…
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July 30, 2015
Lessons from CA: Ensuring Medi-Cal Plans Provide Durable Medical Equipment
Abbi Coursolle, Kim Lewis, and dfitzgerald Issue Brief
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