Tips for success in mental health managed care

Lessons from pilot will strengthen program

In its official report to the Colorado State Legislature, the Capitation Program Advisory Committee offered specific recommendations for the future of the state’s Medicaid mental health managed care program that apply to any organization taking those first steps down the road to capitated mental health services. (For a detailed discussion of the pilot program, see pp. 104 and 105.)

Those recommendations include:

• Assign weight in the evaluation of proposals to those request-for-proposal requirements that directly impact service availability and quality.

• Help implement an independent ombudsman program for assisting Medicaid recipients and helping monitor the program’s effectiveness.

• Require mental health assessment and service agencies (MHASAs) to screen all clients for the presence of medical illnesses that may be causing or exacerbating symptoms of mental illness and refer the patient for medical treatment when appropriate.

• Require that MHASAs not interfere with appropriate medical care decisions rendered by its own or outside providers, and require MHASAs to disclose any and all provider incentive programs.

• Require MHASAs to provide all Medicaid recipients a written description (in their primary language) of all treatment programs and services available, including the criteria and procedures for accessing each program and service.

• Require that any insurance and other reserves that MHASAs set aside revert to the Medicaid managed mental health program for use after termination of the managed care program contract.

• Clearly define administrative costs and how excess revenues will be spent.

• Specify the minimum follow-up steps an MHASA must take when a consumer unexpectedly misses an appointment or drops from service.

(Editor’s note: The entire report to the state legislature on the Medicaid managed mental health pilot program is available on the Internet at http://www. state.co.us. After entering the state of Colorado’s Web site, go to "government" and then "human services" to locate the report.)