Etc. (listed in MaineCare manual) Transportation Broker Procurement in N/A N/A N/A N/A N/A N/A progress Program Integrity Utilization of Recovery Develop $6.5M $2.4M Pros: N/A Implementation Timeline: Audit Contractors operational policy Internal safeguard against fraud, 6-12 mo. Centralized provider and procedure to abuse, and waste Savings Realization Timeline: enrollment process handle day to day Promoting uniform standards 12+ mo. Centralized program Medicaid Understanding of current fiscal Changes: Systems, Human integrity training across all discretionary enrollment status resource expansion or pertinent agencies functions and Improve accuracy of strategic redirect Annual audit review by Internal review of forecasts Communication: Data external agency or data collected Stronger for federal review team, Internal policy contractor Utilize CMS’s best reimbursement team Ongoing review of practice annual Provide state with safeguards in Document: Develop criteria Medicaid policy and summary report disputes with the federal government procedure Develop Federal partnership best policy/procedure practice implementation and mechanisms (except CMS best practice for reporting to the annual summary report) Medicaid and CHIP Payment and Access Commission TOTAL SAVINGS for Mid-term strategies $16.5M $6.3M Long-Term Investment in Primary Care – Value-based Patient Increase Centered promotion Medical $5.2M $2.0M N/A Implementation Timeline: Pros: purchasing of targeted Encourage appropriate level of care in 18-24 mo. Accountable initiatives Communities appropriate care setting Savings Realization Timeline: Primary Care ED Provider Better health outcomes 1-3 years Incentive Program Cons: Changes: Systems (possibly) Maternal & child health
Etc. (listed in MaineCare manual) Transportation Broker Procurement in progress N/A N/A N/A N/A N/A N/A Program Integrity Utilization of Recovery Audit Contractors Centralized provider enrollment process Centralized program integrity training across all pertinent agencies Annual audit review by external agency or contractor Ongoing review of Medicaid policy and procedure Federal partnership best practice implementation (except CMS best practice annual summary report) Develop operational policy and procedure to handle day to day Medicaid discretionary functions and Internal review of data collected Utilize CMS’s best practice annual summary report Develop policy/procedure and mechanisms for reporting to the Medicaid and CHIP Payment and Access Commission $6.5M $2.4M Pros: Internal safeguard against fraud, abuse, and waste Promoting uniform standards Understanding of current fiscal enrollment status Improve accuracy of strategic forecasts Stronger for federal reimbursement Provide state with safeguards in disputes with the federal government N/A Implementation Timeline: 6-12 mo. Savings Realization Timeline: 12+ mo. Changes: Systems, Human resource expansion or redirect Communication: Data review team, Internal policy team Document: Develop criteria TOTAL SAVINGS for Mid-term strategies $16.5M $6.3M Long-Term – Investment in Primary Care Value-based purchasing Patient Centered Medical Accountable Communities Primary Care Provider Incentive Program Increase promotion of targeted initiatives ED Maternal & child health $5.2M $2.0M Pros: Encourage appropriate level of care in appropriate care setting Better health outcomes Cons: N/A Implementation Timeline: 18-24 mo. Savings Realization Timeline: 1-3 years Changes: Systems (possibly)
recommendation-report12-15-2012.docx