Hhsc managed care contracts

HHSC has reported 48 active managed care contracts worth $91.7 billion. All have the required attestation letter. The term of each contract varies. • LBB staff are authorized to conduct reviews of contracts to ensure compliance with best practices and any applicable statues, rules, policies, and procedures. Managed care is a system of delivering health care in which the state contracts with managed care organizations (MCOs) to provide services to Medicaid members and pays the MCOs a per member per month amount (premium or capitation payment). HHSC is responsible for monitoring MCO contract compliance, service utilization,

The HHS Contract Management Handbook (PDF) establishes consistent contract management policies and procedures that must be followed by HHS agencies. The HHS Procurement Manual (PDF) serves as a purchasing guide for HHS agencies and establishes requirements for interface between the Procurement and Contracting Services Division of and HHS agencies for purchases conducted by PCS on behalf of the agencies. Managed Care Organization Sanctions Texas Government Code §533.0072 requires the Texas Health and Human Services Commission to post information regarding contract enforcement actions taken against Medicaid managed care organizations. HHSC announced Thursday a contract with Deloitte, Inc. to review, report, and conduct required studies outlined in the General Appropriations Act of the 85th legislative session. The studies dig into the efficacy of the state’s purchasing and evaluate best practices within CHIP and Medicaid. Managed Care Contract (UMCC), the Uniform Managed Care Manual, and applicable state rules and statutes. WHAT OIG RECOMMENDS . HHSC should require Molina to achieve full compliance and strengthen its pharmacy benefit functions related to the Medicaid and CHIP formularies, the Medicaid PDL, MAC lists, prior authorization, Managed Care is healthcare provided through a network of doctors, hospitals, and other healthcare providers responsible for managing and delivering quality, cost-effective care. Currently, STAR+PLUS Managed Care Organizations include the following: Superior STAR+PLUS; Superior STAR Health; United Healthcare Community Plan; Cigna-Healthspring; Molina; Amerigroup Note: Updated MCO information can be found on the HHSC CFC web page. return to top | previous page | next page The Texas Health and Human Services Commission (HHSC) has decided to cancel the new CHIP RSA contracts and provide an extension of Molina Healthcare’s existing contract. Regardless of any changes in the contracting process, Molina remains steadfastly committed to providing children across Texas with access to high quality health care. All Managed Care Programs: David Hufstedler. Rachel Butler. Michael Joyner. Jeremy Vasek (512) 462-6220 (512) 462-6219 (512) 462-6221 (512) 428-1925

All Managed Care Programs: David Hufstedler. Rachel Butler. Michael Joyner. Jeremy Vasek (512) 462-6220 (512) 462-6219 (512) 462-6221 (512) 428-1925

The Texas Health and Human Services Commission (HHSC) has decided to cancel the new CHIP RSA contracts and provide an extension of Molina Healthcare’s existing contract. Regardless of any changes in the contracting process, Molina remains steadfastly committed to providing children across Texas with access to high quality health care. All Managed Care Programs: David Hufstedler. Rachel Butler. Michael Joyner. Jeremy Vasek (512) 462-6220 (512) 462-6219 (512) 462-6221 (512) 428-1925 HHSC has reported 48 active managed care contracts worth $91.7 billion. All have the required attestation letter. The term of each contract varies. • LBB staff are authorized to conduct reviews of contracts to ensure compliance with best practices and any applicable statues, rules, policies, and procedures. Managed care is a system of delivering health care in which the state contracts with managed care organizations (MCOs) to provide services to Medicaid members and pays the MCOs a per member per month amount (premium or capitation payment). HHSC is responsible for monitoring MCO contract compliance, service utilization, The managed care model is administered through managed care organizations (MCOs) and dental maintenance organizations (DMOs) that are licensed by the Texas Department of Insurance (TDI) and contracted by HHS. Each MCO and DMO under contract with HHS administers Texas Medicaid managed care benefits for their members. NEMT delivery model is performed in contiguous counties within a managed transportation service region. HHSC also contracts with two Full Risk Brokers to coordinate transportation using a network of providers in the Dallas Fort Worth and Houston/Beaumont services delivery areas (SDAs). Agency Procurement Number Procurement Name Program Name Release Date Closing Date; HHSC: HHS0005086: Staffing Agency Services Covering Health Professionals and Allied Health Professionals

Agency Procurement Number Procurement Name Program Name Release Date Closing Date; HHSC: HHS0005086: Staffing Agency Services Covering Health Professionals and Allied Health Professionals

Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per person to provide all services. The Department   A Checklist For Reviewing Managed Care Contracts. S Ziel. Keywords. contract, education, legal, licensed health professionals, managed care, medicine, nursing ,  CYSHCN, finding that a majority of states use general managed care contract HHSC will consider requests for exceptions to the distance standards for all. HHSC amended the Medicaid managed care contracts to allow MCOs to only contract with a NF that has a valid certification, license, and contract with HHSC, and  CHIP Rural Service Area Contract (PDF) Dental Services Managed Care Managed Care Contracts and Manuals | Texas Health and Human Services To get the latest information on the coronavirus (COVID-19), click here .

The managed care model is administered through managed care organizations (MCOs) and dental maintenance organizations (DMOs) that are licensed by the Texas Department of Insurance (TDI) and contracted by HHS. Each MCO and DMO under contract with HHS administers Texas Medicaid managed care benefits for their members.

Following a competitive procurement, HHSC has awarded contracts to the following managed care organizations in the corresponding service areas for the STAR+PLUS product. This will be for an initial contract term of 3 years and anticipated to have an operational effective date of September 1, 2020. Managed care is a system where the overall care of a patient is overseen by a single provider or organization as a way to improve quality and control costs. The manual below defines procedures that Managed Care Organizations (MCOs) must follow in order to meet certain requirements in the HHSC managed care contracts, and to provide interpretation on contractual provisions that need clarification.

Following a competitive procurement, HHSC has awarded contracts to the following managed care organizations in the corresponding service areas for the STAR+PLUS product. This will be for an initial contract term of 3 years and anticipated to have an operational effective date of September 1, 2020.

Contractual Document (CD) Subject: Attachment A – Medicaid and CHIP Managed Care Services RFP, Uniform Managed Care Contract Terms and Conditions Version 2.29 DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Section 10.05 is modified to include the Medicaid The HHS Contract Management Handbook (PDF) establishes consistent contract management policies and procedures that must be followed by HHS agencies. The HHS Procurement Manual (PDF) serves as a purchasing guide for HHS agencies and establishes requirements for interface between the Procurement and Contracting Services Division of and HHS agencies for purchases conducted by PCS on behalf of the agencies. Managed Care Organization Sanctions Texas Government Code §533.0072 requires the Texas Health and Human Services Commission to post information regarding contract enforcement actions taken against Medicaid managed care organizations. HHSC announced Thursday a contract with Deloitte, Inc. to review, report, and conduct required studies outlined in the General Appropriations Act of the 85th legislative session. The studies dig into the efficacy of the state’s purchasing and evaluate best practices within CHIP and Medicaid.

Federal and State requirements and its managed-care contracts relating to the The Texas Health and Human Services Commission (HHSC) received a draft  Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per person to provide all services. The Department   A Checklist For Reviewing Managed Care Contracts. S Ziel. Keywords. contract, education, legal, licensed health professionals, managed care, medicine, nursing ,  CYSHCN, finding that a majority of states use general managed care contract HHSC will consider requests for exceptions to the distance standards for all. HHSC amended the Medicaid managed care contracts to allow MCOs to only contract with a NF that has a valid certification, license, and contract with HHSC, and  CHIP Rural Service Area Contract (PDF) Dental Services Managed Care Managed Care Contracts and Manuals | Texas Health and Human Services To get the latest information on the coronavirus (COVID-19), click here . Following a competitive procurement, HHSC has awarded contracts to the following managed care organizations in the corresponding service areas for the STAR+PLUS product. This will be for an initial contract term of 3 years and anticipated to have an operational effective date of September 1, 2020.