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- August 19, 2014
Network Adequacy Laws in Medi-Cal Managed Care Plans
Read moreMedi-Cal managed care plans are capitated, meaning they receive a set payment per enrollee per month in exchange for providing services.The plans contract on a "comprehensive risk" basis, which means they accept the risk of incurring a loss if they spend more on services than they receives through the…
- August 19, 2014
Managed Care in CA Series, Issue 1: Network Adequacy Laws (Revised May 7, 2018)
Read moreManaged Care and California Series Issue 1: Medi-Cal managed care plans are capitated, meaning. they receive a set payment per enrollee per month in exchange for providing services. The plans contract on a "comprehensive risk" basis, which means they accept the risk of incurring a loss if they spend…
- June 24, 2014
Medicaid and SCHIP Reimbursement Models for Language Services
Read moreIn 2000, the Centers for Medicare & Medicaid Services (CMS) reminded states that they could include language services as an administrative or optional covered service in their Medicaid and State Children's Health Insurance Programs, and thus directly reimburse providers for the costs of these services for program enrollees. Yet…
- May 5, 2014
Manual: Toward a Healthy Future: Medicaid EPSDT Services for Poor Children
Read moreTimely screening examinations and necessary medical treatment are needed to maintain and improve children's health. Lower-income children are at particular risk for health problems. Thus, the Medicaid Act entitles them to comprehensive screening and treatment through a service called Early and Periodic Screening, Diagnostic and Treatment (EPSDT). More than…
- May 2, 2014
Early and Periodic Screening, Diagnosis and Treatment – Annotated Federal Document
Read moreThis memorandum updates an August 18, 1993 memo from the National Health Law Program that annotated EPSDT-related transmittals issued by the Health Care Financing Administration (HCFA). The August 1993 memo listed federal documents issued during the 1989-1993 time period. This memo adds documents covering primarily the 1992-1994 time period.…
- March 31, 2014
Lessons from CA: Pediatric Dental Coverage in the Exchange
Read moreThe Affordable Care Act requires that all plans in the Marketplace and non-grandfathered plans in the individual and small group markets cover pediatric dental services as an essential health benefit. In this Lessons from California, we explore the options that states have to implement these new requirements, and strategies…