How will managed care plans work with legal mandates (parole supervision, etc.)?
New York State expects managed care plans and providers to continue to follow any legal/court mandated aspects of treatment.
New York State expects managed care plans and providers to continue to follow any legal/court mandated aspects of treatment.
The NYS website offers formal guidance and providers should refer to their own policies and standards around HIPAA: https://www.omh.ny.gov/omhweb/hipaa/phi_protection.html
The provider will have to communicate with the managed care plan to determine how to handle this client. Usually a single case agreement will be reached.
A specific list of outliers will likely not be generated because context is key to determining an outlier.
Typically no, a provider is not required to provide care before the managed care plan gives authorization. Exceptions include if there is a crisis situation or an organization's own policies and procedures require them to provide care.
This varies by program and service type. Please refer to MCTAC's guidance on utilization management on our website's resources page, found here.
There isn't one path fits all -- depends on an organization's size, how many clients, and how many contracts with MCOs. A recommended approach is to balance centralized vs individual. Consider how well equipped a central staff, social worker or nurse is able to speak to a case just by looking at a chart? On the other side, training 20 people to do UM reduces the amount of time they can spend on other things. Also raises question of supervision.