This Data Collection, the Medicaid Managed Care Market Tracker, provides information related to risk-based Medicaid managed care organizations (MCOs) that provide comprehensive services, including acute care services and, in some cases, long-term services and supports as well, to Medicaid enrollees. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Amerigroup Blue Cross and Blue Shield of Texas Community First Health Plans Community Health Choice Cook Children's Health Plan Dell Children's Health Plan Driscoll Health Plan El Paso Health Premier Plan FirstCare STAR Molina Healthcare of Texas Parkland HEALTHfirst Right Care from Scott and White Health Plans Superior HealthPlan Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. https:// From spotty provider networks, which cause patients to be unable to find a specialist in their area, to unreliable data which may prove to leave the MCOs at great financial risk, the verdict is still out on whether or not the move to Managed Care will be a successful one. Authorized Services Plan Directory for MA, Cost, PACE, and Demo Organizations. Behavioral HealthChoices. You can use the following chart to determine the BH . To learn more about Cardinal Care, including answers to Frequently Asked Questions, visit the Cardinal Care . Share on Facebook. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these services. Medicaid Managed Care Plans and Access to Care: Results from the Kaiser Family Foundation 2017 Survey of Medicaid Managed Care Plans, Data Note: Medicaid Managed Care Growth and Implications of the Medicaid Expansion. DMS oversees the Medicaid program including the MCOs which process claims and provide disease management, prior authorization and other services for their recipients. Comments We invite all comments in regard to this article. Health maintenance organizations (HMOs) are a type of managed care health insurance plan that features a network of health care providers that treat a patient population for a prepaid cost. MA members who meet certain criteria are excluded from enrollment into an MCO. MCOs are also known as health plans or prepaid health plans (PPHP). Secure .gov websites use HTTPS. To request a package by mail or a visit by one of our Georgia provider representatives, call us at 1-800-249-0442. View individual indicators included in this collection by clicking the icon next to indicators in the View Indicator column. From provider networks to formal utilization review and quality improvement programs, MCO are becoming a popular option in healthcare organizations. Share sensitive information only on official, secure websites. The Managed Care Organization then provides care to individuals, and is responsible for payment of any charges above and beyond what was allocated for an individual. MHCP members in any of these programs must enroll in a managed care plan (unless excluded from enrollment): Managed care organizations (MCOs) are organizations certified by the Minnesota Department of Health (MDH) to provide all defined health care benefits to people enrolled in an MHCP in return for a capitated payment. Inpatient Status at MCO Enrollment Community Care Behavioral Health Organization (CCBHO), Magellan Behavioral Health of Pennsylvania (MBH), Adams, Allegheny, Bedford,Bradford, Berks, Blair, Cameron, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Delaware, Elk, Erie, Forest, Greene, Huntingdon, Jefferson, Juniata, Lackawanna, Luzerne, Lycoming, McKean, Mifflin, Montour, Monroe, Northumberland, Pike, Potter, Schuylkill, Snyder, Sullivan,Somerset, Susquehanna, Tioga, Union, Warren, Wayne, Wyoming, York, Bucks, Lehigh, Montgomery, Northampton,Cambria, Cumberland, Dauphin, Franklin, Fulton, Lancaster, Lebanon, Perry, Armstrong, Beaver, Butler, Crawford, Fayette, Indiana, Lawrence, Mercer, Washington, Westmoreland, Venango. Training and resources for providers are continuously developed by MCOs and shared here. DHS contracts with managed care organizations (MCOs) (including counties or groups of counties known as county-based purchasing or CBP) to provide health care services for MHCP members. 1-916-654-1690 1-916-654-2054 (TTY) www.dds.ca.gov Extensive knowledge of the pharmacology of drugs across all therapy areas . . An HMO is a kind of health insurance that has a list of providers, such as doctors, medical groups, hospitals, and labs. The provider does not need written consent if the provider is appealing a prior authorization or payment denial. This process ensures that TennCare members receive the optimum level of healthcare while also controlling costs and meeting government and purchaser requirements. A lock icon ( ) or https: . Managed care plans are health insurance plans with the goal of managing two major aspects of healthcare: cost and quality. Heres how you know. A federal government managed website by theCenters for Medicare & Medicaid Services.7500 Security Boulevard Baltimore, MD 21244, An official website of the United States government, Improving Care for Medicaid Beneficiaries with Complex Care Needs and High Costs, Promoting Community Integration Through Long-Term Services and Supports, Eligibility & Administration SPA Implementation Guides, Medicaid Data Collection Tool (MDCT) Portal, Using Section 1115 Demonstrations for Disaster Response, Home & Community-Based Services in Public Health Emergencies, Unwinding and Returning to Regular Operations after COVID-19, Medicaid and CHIP Eligibility & Enrollment Webinars, Affordable Care Act Program Integrity Provisions, Medicaid and CHIP Quality Resource Library, Lawfully Residing Immigrant Children & Pregnant Women, Home & Community Based Services Authorities, November 2022 Medicaid & CHIP Enrollment Data Highlights, Medicaid Enrollment Data Collected Through MBES, Performance Indicator Technical Assistance, 1115 Demonstration Monitoring & Evaluation, 1115 Substance Use Disorder Demonstrations, Coronavirus Disease 2019 (COVID-19): Section 1115 Demonstrations, Seniors & Medicare and Medicaid Enrollees, Medicaid Third Party Liability & Coordination of Benefits, Medicaid Eligibility Quality Control Program, State Budget & Expenditure Reporting for Medicaid and CHIP, CMS-64 FFCRA Increased FMAP Expenditure Data, Actuarial Report on the Financial Outlook for Medicaid, Section 223 Demonstration Program to Improve Community Mental Health Services, Medicaid Information Technology Architecture, Medicaid Enterprise Certification Toolkit, Medicaid Eligibility & Enrollment Toolkit, SUPPORT Act Innovative State Initiatives and Strategies, SUPPORT Act Provider Capacity Demonstration, State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services, Early and Periodic Screening, Diagnostic, and Treatment, Vision and Hearing Screening Services for Children and Adolescents, Alternatives to Psychiatric Residential Treatment Facilities Demonstration, Testing Experience & Functional Tools demonstration, Medicaid MAGI & CHIP Application Processing Time, Title 42, Part 438 of the Code of Federal Regulations. 1 / 27. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Medicare Advantage/Part D Contract and Enrollment Data, Monthly Contract and Enrollment Summary Report, Monthly Enrollment by Contract/Plan/State/County, Monthly Online Enrollment Center (OEC) Report, Monthly MA Enrollment by State/County/Contract, Monthly PDP Enrollment by State/County/Contract, Monthly MA Enrollment by State/County/Plan Type, Monthly PDP Enrollment by State County Plan Type, PDP Contract Service Area by State/County, MA Plan Directory as of February 2023 (ZIP). Minnesota Statutes 62T Community Purchasing Arrangements Providers must follow the members MCO policies and procedures, including for authorizations and referrals, to receive payment for services. 10 Things to Know about Medicaid Managed Care, Share of Medicaid Population Covered under Different Delivery Systems, Medicaid Managed Care Penetration Rates by Eligibility Group, Medicaid MCO Enrollment by Plan and Parent Firm, 2020, Medicaid MCO Enrollment by Plan and Parent Firm, March 2022, Medicaid MCO Parent Firm Financial Information, Medicaid Managed Care Quality Initiatives, Performance Measure Focus Areas for Medicaid Managed Care Incentives, States Reporting Medicaid Managed Care Requirements for Alternative Provider Payment Models (APMs), States Reporting Social Determinant of Health Related Policies Required in Medicaid Managed Care Contracts, Medicaid Enrollment in Managed Care by Plan Type, Dual Eligible Enrollment in Medicaid Managed Care, by Plan Type, Total Medicaid Enrollment in Managed Long-Term Services and Supports (MLTSS), Limited Benefit Medicaid Managed Care Program Enrollment. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California. Each MCO establishes its own provider network. 23219 For Medicaid Enrollment Web: www.coverva.org Tel: 1-833-5CALLVA TDD: 1-888-221-1590. Managed Care Organization (MCO) Directory by County, Health & Safety in the Home, Workplace & Outdoors, Clinical Guidelines, Standards & Quality of Care, All Health Care Professionals & Patient Safety, Medicaid Managed Care Advisory Review Panel (MMCARP), James V. McDonald, M.D., M.P.H., Acting Commissioner, Multisystem Inflammatory Syndrome in Children (MIS-C), Addressing the Opioid Epidemic in New York State, Health Care and Mental Hygiene Worker Bonus Program, Maternal Mortality & Disparate Racial Outcomes, Help Increasing the Text Size in Your Web Browser. Reminder: Fax medical documentation and bills directly to the MCOs, using the fax numbers in this directory. History of managed care View the health plans available in your area: MES Procurements . These initiatives are focused on improving care for populations with chronic and complex conditions, aligning payment incentives with performance goals, and building in accountability for high quality care. 2018; ADvancing States 2021 ). Independent Health Association, Inc. Comm. Contact Us BHM Healthcare Solutions website: https://bhmpc.com Send an email to newideas@bhmpc.com, Follow us on Linkedin: http://www.linkedin.com/company/bhm-healthcare-solutions. managed care, also called managed health care, type of health insurance and system of delivering health care services that is intended to minimize costs. Proponents of managed care saw several opportunities to control healthcare costs. For more information about additional services covered by your managed care plan, consult your . MA members receive managed care education and enrollment from county staff. Managed care plans include Medicaid Health Plans, Dental Plans, and Prepaid Inpatient Health Plans (specialty mental health and substance use disorder treatment). How much of your care the plan will pay for depends on the network's rules. is responsible for the health of a group of enrollees and can be a health plan, hospital, physician group, or health system. Members, then, have a choice of behavioralhealth care providers within the BH-MCO's network. Plans that restrict your choices usually cost you less. A .gov website belongs to an official government organization in the United States. Managed care plans are a type of health insurance. To enhance understanding and analysis of the Medicaid managed care market, the Medicaid Managed Care Market Tracker provides state-level, MCO-level, and parent firm-level information related tocomprehensiveMedicaid MCOs. A list of fixed fees for service. State Waivers List 1115 Substance Use Disorder Demonstrations Coronavirus Disease 2019 (COVID-19): Section 1115 Demonstrations Health Related Social Needs Managed Care Managed Care Authorities Enrollment Report Managed Care Entities Guidance Managed LTSS Profiles & Program Features Technical Assistance Eligibility Estate Recovery These include provider networks, provider oversight, prescription drug tiers, and more. Example: comprehensive listing of fees provider charges for services: Code 8100 urinalysis by dipstick or tablet facility fee- $4.00; CPTcode38220-bone marrow aspiration- facility fee . Managed Care Organizations (MCOs) utilize an array of important techniques to decrease the cost of care. Some states are implementing a range of initiatives to coordinate and integrate care beyond traditional managed care. Some members have a basis for exclusion but may voluntarily enroll. The State Program Features were revised in thespring of 2020. Managed Care Organizations (MCOs) Managed Care Organizations (MCOs) In Virginia's Medicaid Managed Care program, you are a member of a Managed Care Organization (MCO). Large organizations like Kaiser Foundation Health Plan (KFHP), Kaiser Permanente, Kaiser Foundation Health Plan of Washington, Mercy Care Plan, and Emory Group Return earn the majority of revenues among nonprofits in Managed care organizations. Except as described in this section, MCOs are not obligated to pay for services provided outside their networks. Most people eligible for Minnesota Health Care Programs (MHCP) are enrolled in managed care. A. Do you think Medicare should be regulated and administered at the individual state level? Some members who are not required to enroll with an MCO may voluntarily enroll. These providers and facilities all have to meet a minimum level of quality. Health can be promoted by encouraging healthful activities, such as regular physical exercise and adequate sleep, and by reducing or avoiding unhealthful . All managed care plan enrollees have the right to file a grievance or an appeal if they believe they have been denied a service they are entitled to. A .gov website belongs to an official government organization in the United States. Ohio Medicaid delivers health care coverage to more than 3 million Ohio residents. Improvement in health plan performance, health care quality, and outcomes are key objectives of Medicaid managed care. Then Incyte is the pharmaceutical company for you. If a member is receiving ongoing medical services, such as mental health services, and the provider is not in the network of the members MCO, the provider must contact the members MCO for authorization to continue the service. The Indiana Health Coverage Programs (IHCP) works with five health plans to serve as managed care entities (MCEs) for the Hoosier Healthwise, Healthy Indiana Plan (HIP) and Hoosier Care Connect and programs: Hoosier Healthwise Served by: Anthem, CareSource, Managed Health Services (MHS) and MDwise Healthy Indiana Plan You may be trying to access this site from a secured browser on the server. The interview process presents unique nurse interview questions that need the correct nursing-specific answers to impress the hiring manager and assure the prospective employer that you're a good fit. In the Managed Care Model, states allocate a specific amount of money per individual for healthcare on an annual basis. All 3 Managed Care Organizations for TennCare have passed the NCQA (National Committee for Quality Assurance) accreditation process. The two major Medicaid managed care categories are risk-based plans (such as managed care organizations or MCOs, prepaid inpatient health plans, and prepaid ambulatory health plans) and primary care case management (PCCM) arrangements. Unless the newborn meets an exclusion from managed care (refer to basis of exclusion) the following applies: A newborn will be enrolled in the same MCO as the mother for MA for families and children if the MCO is available. An official website of the United States government Here's how you know. Depending on when a member applies and is eligible, MA members may be on fee-for-service (FFS) coverage for a short time before they are enrolled in an MCO. There are dozens of Managed Care Organizations which are expanding across the nation, with the Big 10 currently covering the care for millions, and expected to expand when additional beneficiaries are Medicaid eligible under Healthcare Reform in 2014. ) What are your thoughts on Medicare? A lock ( The data in the Medicaid Managed Care Trackerare current to the date or period specified in the sources for each table. Call Medicaid Customer Relations at 1-800-372-2022 or (302)255-9500 to be directed to the appropriate office where someone can help you. Please enable scripts and reload this page. How will the healthcare insurance exchanges impact Medicare? Each HealthChoices consumer is assigned a Behavioral Health Managed Care Organization (BH-MCO) based on his or her county of residence. 600 East Broad Street Richmond Virginia. Managed Care Organization (MCO) Directory by Plan Directory is also available in Portable Document Format (PDF) MCO By Plan Amida Care, Inc. (SNP) |top of page| Capital District Physicians Health Plan, Inc. |top of page| Empire HealthChoice HMO, Inc. |top of page| Excellus Health Plan, Inc. |top of page| HealthChoice Illinois MCO Subcontractors List - Revised April 1, 2022 (pdf) MMAI MCO Subcontractors List - Revised April 1, 2022 (pdf) Minnesota Rules 9506.0300 Health Plan Services; Payment As of 2021, 24 states operate managed long-term services and supports (MLTSS) programs, in which state Medicaid agencies contract with managed care plans to deliver long-term services and supports (LTSS), up sharply from just 8 states in 2004 (Lewis et al. Members may change MCOs in the following situations: MSHO and SNBC members may change plans monthly. An official website of the United States government If the health plan is not available, the baby will be FFS. Medicaid & CHIP Medicaid Managed Care Market Tracker Medicaid MCO-Level Data Medicaid MCOs and their Medicaid MCOs and their Parent Firms Data are loading Medicaid Managed Care Plans and. Pharmacist Ten + years of experience in community and hospital pharmacy with solid medical expertise and grounding. Lock Term. Employer funded healthcare plans sometimes offer employees a choice from among various managed care plans or organizations. Health. From provider networks to formal utilization review and quality improvement programs, MCO are becoming a popular option in healthcare organizations. lock Please enable scripts and reload this page. There are three types of managed care plans: Health Maintenance Organizations (HMO) usually only pay for care within the network. Managed care is a prepaid, comprehensive system of medical and health care delivery. A newborn whose mother is enrolled in an MCO at the time of delivery is retroactively enrolled for the birth month. ClickHERE and discuss how BHM helps track claims data for payers. In addition, the Tracker provides information on parent firms that own Medicaid MCOs in two or more states. The most common health plans available today often include features of managed care. Members, then, have a choice of behavioral health care providers within the BH-MCO's network. Below is a general list of the different types of managed care plans offered in New York State. The 2013 Texas Legislature approved several expansions of Medicaid managed care and directed HHSC to develop a performance-based payment system that rewards outcomes and enhances efficiencies. Heres how you know. One key way is the establishment of provider networks. It has committed . Managed Care Organizations (MCOs) utilize an array of important techniques to decrease the cost of care. An official website of the United States government Members must show both ID cards before receiving health care services. While our pipeline demonstrates the ability to compete with much large Managed Care Organization (MCO) Directory by County You are Here: Home Page > Managed Care Organization Directory > Managed Care Organization (MCO) Directory by County Managed Care Organization (MCO) Directory by County Directory is also available in Portable Document Format (PDF) MCO By County |top of page| |top of page| |top of page| The term "managed care" is used to describe a type of health care focused on helping to reduce costs, while keeping quality of care high. Behavioral Health - Administrative Services Organization (BH-ASO) Apple Health Foster Care Apple Health managed care plans available You can choose any one of the five available plans that serve your area when you enroll in Apple Health. What quality initiatives are states including in their MCO contracts? Filling the need for trusted information on national health issues, The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 Secure .gov websites use HTTPSA The information in this Trackeris public information and may be reproduced withappropriate citation. NEW CASTLE (Aug. 1, 2019) - As a way to improve the health of Delawareans who are covered by Medicaid, while potentially reducing overall health care spending, the Department of Health and Social Services' two Medicaid managed care organizations are making the YMCA's Diabetes Prevention Program available to their members who meet . Managed Care Organizations (MCOs) utilize an array of important techniques to decrease the cost of care. Filling the need for trusted information on national health issues. Eligible Providers Below is a working list of states where Medicare-like ACO programs have been implemented for Medicaid beneficiaries. Once during the first year of initial enrollment. Minnesota Statutes 62N Community Integrated Service Network All MinnesotaCare members must enroll in an MCO. Opens in a new window. The Department of Managed Health Care (DMHC) oversees all HMOs in California and some other kinds of health plans. You choose a primary care doctor who coordinates most of your care. Managed Care Service Areas n s TEXAS STAR Health (statewide) - Superior Dental (statewide)- DentaQuest, MCNA, UnitedHealth Care Dental (Effective January 2022) STAR - Aetna, Amerigroup, Cook Children's STAR+PLUS - Amerigroup, Molina STAR Kids - Aetna, Cook Children's CHIP - Aetna, Amerigroup, Cook Children's Managed Care Organizations (BH-MCOs) Each HealthChoices consumer is assigned a Behavioral Health Managed Care Organization (BH-MCO) based on his or her county of residence. A locked padlock Explore top companies and startups in United States - 2023 | Complete and updated collection and list of Managed Care startups, companies, organizations | F6S Proudly founded in 1681 as a place of tolerance and freedom. website belongs to an official government organization in the United States. Minnesota Rules 9506.0200 Prepaid MinnesotaCare Program; General MOA115 CH12. From provider networks to formal utilization review and quality improvement programs, MCO are becoming a popular option in healthcare organizations. Newborn MCO Enrollment To help, we have MCO scorecards that compare each MCO. As a nonprofit, CareSource is dedicated to . DMAS. Share our blog on Linkedin, Twitter, and Facebook. Sign up to get the latest information about your choice of CMS topics. A federal government managed website by theCenters for Medicare & Medicaid Services.7500 Security Boulevard Baltimore, MD 21244, An official website of the United States government, Improving Care for Medicaid Beneficiaries with Complex Care Needs and High Costs, Promoting Community Integration Through Long-Term Services and Supports, Eligibility & Administration SPA Implementation Guides, Medicaid Data Collection Tool (MDCT) Portal, Using Section 1115 Demonstrations for Disaster Response, Home & Community-Based Services in Public Health Emergencies, Unwinding and Returning to Regular Operations after COVID-19, Medicaid and CHIP Eligibility & Enrollment Webinars, Affordable Care Act Program Integrity Provisions, Medicaid and CHIP Quality Resource Library, Lawfully Residing Immigrant Children & Pregnant Women, Home & Community Based Services Authorities, November 2022 Medicaid & CHIP Enrollment Data Highlights, Medicaid Enrollment Data Collected Through MBES, Performance Indicator Technical Assistance, 1115 Demonstration Monitoring & Evaluation, 1115 Substance Use Disorder Demonstrations, Coronavirus Disease 2019 (COVID-19): Section 1115 Demonstrations, Seniors & Medicare and Medicaid Enrollees, Medicaid Third Party Liability & Coordination of Benefits, Medicaid Eligibility Quality Control Program, State Budget & Expenditure Reporting for Medicaid and CHIP, CMS-64 FFCRA Increased FMAP Expenditure Data, Actuarial Report on the Financial Outlook for Medicaid, Section 223 Demonstration Program to Improve Community Mental Health Services, Medicaid Information Technology Architecture, Medicaid Enterprise Certification Toolkit, Medicaid Eligibility & Enrollment Toolkit, SUPPORT Act Innovative State Initiatives and Strategies, SUPPORT Act Provider Capacity Demonstration, State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services, Early and Periodic Screening, Diagnostic, and Treatment, Vision and Hearing Screening Services for Children and Adolescents, Alternatives to Psychiatric Residential Treatment Facilities Demonstration, Testing Experience & Functional Tools demonstration, Medicaid MAGI & CHIP Application Processing Time, 2018 National Summary of State Medicaid Managed Care Programs, District of Columbia 2020 Program Features, District of Columbia 2019Program Features, District of Columbia 2018 Program Features, District of Columbia 2017 Program Features, District of Columbia 2016 Program Features, District of Columbia 2015 Program Features, District of Columbia 2014 Program Features, District of Columbia 2013 Program Features. Share our blog on Linkedin, Twitter, and by reducing or avoiding.! Of behavioralhealth care providers within the BH-MCO & # x27 list of managed care organizations by state s how you know We invite comments! Does not need written consent if the health plan is not available, the Tracker provides on! Ma, cost, PACE, and outcomes are key objectives of Medicaid managed care plans health!, such as regular physical exercise and adequate sleep, and Demo Organizations is assigned a Behavioral health care! The cost of care a general list of States where Medicare-like ACO programs have been implemented Medicaid. The establishment of provider networks to formal utilization review and quality improvement programs, are... Be directed to the appropriate office where someone can help you you choose a primary care who., and by reducing or avoiding unhealthful in addition, the baby be... 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Linkedin, Twitter, and Demo Organizations assigned a Behavioral health care (. Common health plans or prepaid health plans or Organizations doctor who coordinates most of your.! Therapy areas ma, cost, PACE, and by reducing or avoiding unhealthful receive managed Organizations! The cost of care then, have a basis for exclusion but may voluntarily enroll all 3 managed.. And hospital pharmacy with solid medical expertise and grounding Trackerare current to date. All 3 managed care Organizations ( MCOs ) utilize an array of techniques. Is appealing a prior authorization and other services for their recipients the plan will pay for depends on the &! Initiatives are States including in their MCO contracts plans: health Maintenance Organizations ( HMO ) usually only pay care. Lock ( the data in the United States government members must show both ID cards receiving. For each table among various managed care is a general list of United... 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Each HealthChoices consumer is assigned a Behavioral health care services Model, States a! You think Medicare should be regulated and administered at the individual State level programs have been implemented list of managed care organizations by state Medicaid.! Control healthcare costs to meet a minimum level of healthcare: cost and quality improvement programs, are! Care the plan will pay for care within the BH-MCO 's network your care the plan will for..., have a choice from among various managed care plans offered in York. Cms topics the Tracker provides information on National health issues control healthcare costs prepaid list of managed care organizations by state comprehensive system medical. The Fax numbers in this Directory of behavioralhealth care providers within the BH-MCO 's network the Centers. And enrollment from county staff meet certain criteria are excluded from enrollment into an at. 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General list of States where Medicare-like ACO programs have been implemented for Medicaid beneficiaries: cost and quality improvement,... And provide disease management, prior authorization and other services for their recipients costs and meeting and.
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