In the latest memo update for all managed care organization starting in Fiscal year 2018, HSS is providing Guidance on Preferred Provider Arrangements and Network Access Requirements. The Medicaid and CHIP managed care contracts, including the Uniform Managed Care Contract (UMCC), will require that managed care organizations (MCOs) continue to transition provider payment methodologies from volume based payment approaches to quality-based alternative payment models (APMs).
APMs are designed to improve health outcomes for members, improve members’ experience of care and lower healthcare cost trends (see UMCC Section 188.8.131.52). One arrangement MCOs may consider to further these goals is a preferred provider arrangement.
The memo states that if an MCO enters into a preferred provider arrangement, the MCO must notify members of the arrangement in writing at least 30 days in advance of execution of the arrangement, consistent with Chapter 4 of the Uniform Managed Care Manual.