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

Publisher: Baltimore, MD: Division of Managed Care Plans, Center for Medicaid and CHIP Services, CMS, U.S. Department of Health and Human Services
Apr 30, 2017
Authors
Debra J. Lipson, Jenna Libersky, Katharine Bradley, Corinne Lewis, Allison Wishon Siegwarth, and Rebecca Lester
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.