Medicaid MCOs → Contracting
Medicaid managed care organizations (MCOs) offering the National Diabetes Prevention Program (National DPP) lifestyle change program will need to work with the state Medicaid agency to set rates, establish cost reporting expectations, and secure amendments to existing contracts. This section provides sample contract language, cost and reimbursement information, and other inputs and considerations relevant to setting and refining rates.
Contracted Medicaid MCOs in states electing to cover the National DPP lifestyle change program will need to amend their existing MCO contracts, at the discretion of the state Medicaid agency. This section provides information regarding contract amendments and provides sample contract language.
According to CDC, approximate costs for administering the National DPP lifestyle change program is $500, but this amount can vary. This section provides information on various program costs, reimbursement models, and how to consider these costs in rate-setting processes.
Contracts between the MCO and CDC-recognized organizations should outline expectations between the parties and include National DPP lifestyle change program requirements. This section includes a list of common elements recommended for inclusion in such contracts.
The Medical Loss Ratio (MLR) is the percentage of an insurer’s premium dollars that is spent on medical care and quality improvement activities. This section describes the MLR requirements for MCOs and where the National DPP lifestyle change program fits within the calculation.