360-10.6 Criteria for designating social services districts to develop and submit
managed care plans.
(a) Each year the commissioner, after consulting with the social
services districts, and on the basis of priority rankings, will designate 20 social
services districts which will be required to develop and submit to the department managed
care plans. This process will continue until all social services districts have been
designated.
(b) The determination of which social services districts will be
designated to develop and submit managed care plans will be based upon criteria which
include health care provider availability and geographic accessibility, potential
cost-effectiveness, and the ability to successfully implement an MCP. The department will
consider such factors as:
(1) the number of MA recipients in the social
services district;
(2) the average cost per client for MA
services;
(3) the number of MA recipients not currently
enrolled in an MCP;
(4) the number of MA recipients who use
community health centers;
(5) the number of MA recipients who use
hospital emergency rooms;
(6) the number and duration of in-patient
hospital admissions of MA recipients; and
(7) the number of physician visits made by MA
recipients.
(c) A social services district may develop and submit a managed care
plan to the commissioner for review before designation by the commissioner.