MCO Frequently Asked Questions
Frequently Asked Implementation Questions
Are long term care, transportation, or pharmacy being included in the services administered by the MCO's? If not, who will administer these servies?
Will beneficiaries be able to keep their current doctors?
West Virginia's contract with the MCO's requires that an SSI member, at the time of initial enrollment, and a member who is currently receiving behavioral health services in the fee-for-service system be allowed to obtaina 90-day exemption to complete an ongoing course oftreatment with his or her current provider, if the provider is not in any of the MCO networks. The MCO will work withthe beneficiary and non-network provider to identify a new provider for ongoing treatment and ensure that an appropriate transition plan is developed. The State has also provided the MCOs with contact information for all SSI, behavioral health, and children’s dental providers who currently see Medicaid patients and has encouraged the MCOs to contract with providers that serve large numbers of Medicaid beneficiaries. In most cases, the MCOs will offer Medicaid providers the same level of payment for services as in the current fee-for-service system. Finally, the State recognizes that many Medicaid beneficiaries access behavioral health services at local comprehensive behavioral health centers and is requiring the MCOs to contract with these centers in their service areas in order to meet the behavioral health provider network access standards.
Long term care, non-emergency transportation services, and pharmacy benefits will continue to be administered to beneficiaries through the Medicaid fee-of-service program, as they are now.
Will beneficiaries have to pay co-payments for servies?
No, beneficiaries will not be required to pay copayments for services, as under the current fee-for-service Medicaid program.
Who will coordinate servies for beneficiaries after expansion of the MCO program?
West Virginia requires MCOs to provide coordination services to assist beneficiaries in arranging, coordinating and monitoring medical and support services. MCOs will educate providers on the importance of informing beneficiaries of specific health care needs that require follow-up; provide training in self-care and other measures they may take to promote their own health; and help them comply with prescribed treatments or regimens.
How will the State ensure successful implementation of the MCO program expansion?
West Virginia plans survey SSI beneficiaries and providers to identify any issues, and will work to quickly resolve any problems that are identified. Issues and lessons learned will be examined closely to resolve issues for the next phase of SSI implementation. The State will also closely track complaints, grievances, and information on how many and what kinds of medical services beneficiaries use to make sure there is ongoing access to quality care.
In 2011, BMS will administer the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to a sample of beneficiaries enrolled in the Medicaid program to assess satisfaction and identify areas for improvement. This survey will include questions focusing on behavioral health and children’s dental services.
How will beneficiaries be notified of the upcoming expansion?
Beneficiaries currently enrolled in an MCO will receive a postcard and a formal letter this fall to notify them of the upcoming program changes, and an updated member handbook, which will explain how to access behavioral health and children’s dental benefits.
The State will also mail SSI beneficiaries a postcard to inform them of the upcoming change several months before they need to enroll in an MCO. Closer to the enrollment date, the State will send an enrollment packet with information on which MCO choices are available and which doctors are in each MCO. Enrollment information will be available in Braille and in large print formats. Choice counselors will also be available for individuals to contact to discuss the changes.