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.
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