Bo Bowen, Director, Demonstration and Special Projects, Managed Care Division, Division of Medicaid, Office of the Governor, Robert E. Lee Building, Suite 801, 239 N. Lamar St., Jackson, MS 39201-1399

B -- DEVELOPMENT OF MODULES OF CAPITATED MANAGED CARE The Division of Medicaid, Office of the Governor, is considering the development of modules of capitated managed care. The Mississippi Legislature has mandated that the Division develop at least one module in an urban area and one in a rural area. Enrollment for Medicaid eligibles will be voluntary. Any organization interested in recommending a pilot program should describe their approach by close of business August 22, 1995. Responses should be limited to fifteen pages. A specific response to each program element is preferred, with clarification of any distinctions recommended between rural and urban programs. Elements to be addressed include but are not limited to the following: Identify the population and the urban/rural geographical area to be served. (e.g., all Medicaid eligibles including elderly and disabled; or only AFDC and AFDC-related). Describe extent of and plans for developing local community support. Address the roles of community providers, such as hospitals, public health clinics, family planning providers, federally qualified health centers (FQHC), community mental health centers, nurse practitioners, rural health clinics, nursing facilities, etc. Describe plans for developing the network of providers participating in the pilot program, the extent to which this plan will establish an integrated delivery system with the capacity to provide continuity of care, and the extent to which this plan has been implemented. Identify any existing agreements with providers to participate in this program. Describe qualifications to provide capitated managed care, including but not limited to state or federal licensure, qualifications or certification, and experience. Program Services: Establish a medical home for clients with emphasis on preventive services. Describe how the plan would assure 24-hour coverage seven days a week. Describe how mental health, long term care, transportation, pharmacy, and preventive health care services will be provided. Describe plans to assure a continuum of care for the client which take into account the cyclical nature of Medicaid eligibility status and which include a description of how clients would be followed through the system. Describe plans to assure high quality of services and the specific outcome measures to be addressed. Identify provisions for assistance and education tailored to the needs of this population and the circumstances of participating providers. Financing: Explain cost efficiencies and savings that will result from the proposal. Describe the reimbursement methodology proposed (i.e., partial or full capitation). Describe strategies for creative financial incentives and disincentives in achieving good health outcomes. Explain capability to manage and handle risk. Describe marketing plans and explain what procedures will ensure that recipients or the Division are not misled, confused or defrauded. Describe any other creative and innovative approaches to a health care delivery system that will promote access to care for Medicaid clients in the most cost effective setting. Data Requirements: Describe provisions that will be made for the collection of data and how these data will be used. Timetable: Timetable for implementation with key milestone dates. For additional information please contact Melba Carr, Bureau Director, Policy and Planning, at 601-359-6050 or via the Internet at http://www.its.state.ms.us/home/dom/. Please submit this information to the address above. (202)

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