Notice of the following actions regarding a new Managed Care Enrollment process

PUBLIC NOTICE: 
SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

The South Carolina Department of Health and Human Services (SCDHHS), pursuant to the requirements of Title 42 Part 447 Section 205 of the Code of Federal Regulations, gives notice of the following actions regarding a new Managed Care Enrollment process change under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

 

Effective on or after January 1, 2013, SCDHHS will change its current Managed Care enrollment process that will improve Medicaid MCO Member access and satisfaction, maximize program efficiency, effectiveness and responsiveness, and reduce operational and service costs.  The Quality Weighted Assignment algorithm is linked to a health plan’s overall score on the Health Plan Report Card.  Health plans with better outcomes will be assigned more members based on their Healthcare Effectiveness Data and Information Set (HEDIS) scores.  The Report Card will be updated twice annually, in July and January.  The first assignments utilizing Quality will occur based on the scores from calendar year 2011 and released in November 2012.  Thereafter, the ratings that are updated in July will be applied beginning in January and the ratings that are updated in January will be applied in July.

 

Copies of this notice are available for public review at each County Department of Health and Human Services Office and at www.scdhhs.gov.  Additional information regarding this action is available upon request at the address cited below.

 

Any written comments submitted may be reviewed by the public at the SCDHHS, Division of Managed Care, Room J1119, 1801 Main Street, Columbia, South Carolina, Monday through Friday between the hours of 9:00 A.M. and 5:00 P.M.

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