The State will evaluate the performance
of each provider's compliance with federal standards (EPSDT) and state
objectives (MSS/ISS). Individual corrective action plans will be established
with measurable objectives for each plan.
The State will provide Technical Assistance
and Best Practices Information to Providers whose Performance is below
acceptable levels.
The State will develop a reimbursement
system for all providers for EPSDT and MSSIISS services which accomplish
the following:
Reimburse no less than acceptable
costs for providing required services (a system similar to
cost based services for Community Health Centers as one model).
Payments to plans will result
when, and only when, services are delivered, i.e. a Performance
Based system. The system should include incentives and disincentives
for reaching or exceeding minimum objectives.
Until systems reach performance
levels in a defined geographic area, the state will provide
recipients access to EPSDT and MSS/ISS services through other
mechanisms, including a fee for service option. (The intent
is that consumers should not be at risk for care while plans
gear up.)
Incentives for providing Prevention
services shall assure that when targets are exceeded, reimbursement
will stimulate and reward such behavior.
Follow-up for identified problems
in the Health Screening process is documented and the provider
must demonstrate adequate efforts to assure patient compliance
when possible.
Assures adequate resources for
outreach and transportation for clients to participate in
the programs.
Principles for Dealing with EPSDT and MSS/IS
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