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Primary Care Case Management (PCCM) is a system of managed care in the US used by state Medicaid agencies, in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment. [1]
All states except Alaska, and Wyoming have all, or a portion of, their Medicaid population enrolled in an MCO. [4] States can make managed care enrollment voluntary, or seek a waiver from CMS to require certain populations to enroll in an MCO. If states provide a choice of at least two plans, they can mandate enrollment in managed care.
This disparity has been linked to lower provider rates of participation in Medicaid programs vs Medicare or commercial insurance, and thus decreased access to care for Medicaid patients. [56] One component of the Affordable Care Act was a federally-funded increase in 2013 and 2014 in Medicaid payments to bring them up to 100% of equivalent ...
Keystone First is a medical assistance (Medicaid and Medicare) managed care health plan based in southeastern Pennsylvania. Keystone focuses on low-income residents in southeastern Pennsylvania counties including, Bucks, Chester, Delaware, Montgomery, and Philadelphia. The healthcare provider currently serves over 400,000 residents in the area. [1]
Carolyne Davis [9] March 1981 August 1985 Ronald Reagan: 7 William L. Roper [9] May 1986 February 1989 Ronald Reagan George H. W. Bush: 8 Gail Wilensky [9] February 1990 March 1992 George H. W. Bush: 9 Bruce Vladeck [9] May 1993 September 1997 Bill Clinton: 10 Nancy-Ann DeParle [9] November 1997 September 29, 2000 11 Thomas A. Scully [9] May ...
In the United States, approximately 9.2 million people are eligible for "dual" status. [1] [2] Dual-eligibles make up 14% of Medicaid enrollment, yet they are responsible for approximately 36% of Medicaid expenditures. [3] Similarly, duals total 20% of Medicare enrollment, and spend 31% of Medicare dollars. [4]
The Center for Medicare and Medicaid Innovation (CMMI; also known as the CMS Innovation Center) is an organization of the United States government under the Centers for Medicare and Medicaid Services (CMS). [1] It was created by the Patient Protection and Affordable Care Act, the 2010 U.S. health care reform legislation.