States Turn to Managed Care To Constrain Medicaid Long-Term Care Costs

Introduction  At least 26 States now contract with managed care organizations (MCOs) to provide long-term services and supports (LTSS) for older adults and people with disabilities. MCOs receive a monthly payment per member to provide comprehensive care and assume the risk of managing the cost of care within that capitated rate. The goal of managed […]

Accurate Encounter Data a Must For Medicaid MCO Quality Measurement

With more than 60% of all Medicaid beneficiaries now enrolled in comprehensive, risk-based managed care organizations (MCOs), state Medicaid agencies that want to measure quality of those plans must have quality encounter data. Encounter data capture the items or services received by the member; they are managed care’s equivalent of claims in fee for service. […]