Medicaid Plan Management Operations
The Bureau of Plan Management Operations is responsible for the primary oversight of Medicaid’s managed care programs, with a focus on the Statewide Medicaid Managed Care (SMMC) program.
Contract management includes ensuring that the managed care plans meet Medicaid contractual requirements, including the timely provision of medically needed services and provider payment for such services. The contract managers in this bureau serve as the primary point of contact for the plans regarding their contract.
Comprehensive Plan Management
This bureau section is responsible for contract management of the comprehensive long-term care (LTC) Medicaid managed care plans and one long-term care only plan. Comprehensive long-term care plans provide both medical assistance and long-term care services to Medicaid enrollees.
Standard Plan Management
This bureau section is responsible for contract management of the medical managed assistance (MMA) Medicaid managed care plans, which provide medical assistance services to Medicaid enrollees.
Specialty Plan Management
This bureau section is responsible for contract management of the Managed Medical Assistance Medicaid managed care plans that provide health care services to special populations: children with chronic conditions and serious medical needs, persons living with HIV and AIDS and the severely mentally ill.
Compliance Coordination
This bureau section is responsible for coordination of contract compliance and enforcement under the SMMC Program. This bureau works with other Agency bureaus and sections to ensure the plan’s compliance with contract requirements, including working with managed care plans statewide to address claims management, marketing and general plan management issues.
