What are MCO Standards Concerning Special Needs Populations?
MCOs must meet specific standards set forth in the regulations for treating seven special needs populations. These include 1) children with special health care needs; 2) individuals with a physical disability; 3) individuals with a developmental disability; 4) pregnant and postpartum women; 5) individuals who are homeless; 6) individuals with HIV/AIDS; 7) individuals with a need for substance abuse treatment; and 8) children under state supervision. The general provisions for special needs populations include: • ensuring that Pediatric and adult Primary Care Providers (PCPs), and specialists are clinically qualified to provide or arrange for specialized services; • developing referral protocols that demonstrate the conditions under which PCPs will make the arrangements for referrals to specialty care networks; • coordinating case management as part of enrollee’s comprehensive plan of care; • identifying a special needs coordinator as a point of contact for health services information a
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