In New Hampshire
- In July of 2011 there were a total of 135,092 beneficiaries enrolled in New Hampshire’s Medicaid program, with none of these beneficiaries enrolled in managed care. However, beginning on December 1, 2013, the state transitioned from fee-for-service to a Medicaid care management program under a Section 1932(a) State Plan Amendment. Physical and behavioral health services are provided under the managed care program, while oral health services remain fee-for-service. Children must enroll in a managed care organization (MCO) and will receive physical and behavioral health services under the EPSDT benefit through the MCO. New Hampshire’s Department of Health and Human services has contracted with three MCOs.
Last updated May 2014
Regulations in New Hampshire define medically necessary as:
“health care services that a licensed health care provider, exercising prudent clinical judgment, would provide, in accordance with generally accepted standards of medical practice, to a recipient for the purpose of evaluating, diagnosing, preventing, or treating an acute or chronic illness, injury, disease, or its symptoms, and that are:
|Initiatives to Improve Access
|Reporting & Data Collection||
Managed care organizations in New Hampshire are required to report on measures sets that include:
In the first year of operation of the managed care program, the Adolescent Well Care Visits HEDIS measure is a performance incentive measure for managed care organizations.
||Behavioral health benefits are included in New Hampshire’s new managed care program. Managed care organizations are required to contract with Community Mental Health Centers to deliver behavioral services to Medicaid beneficiaries, including children with a severe emotional disturbance. Clinicians providing community mental health services to Medicaid-enrolled children must be certified in the use of Child and Adolescent Needs and Strengths Assessment.|
|Support to Providers and Families||
New Hampshire provides resources on Medicaid for families of eligible children, and it provides resources on managed care for beneficiaries
The state also provides a Medicaid Managed Care Question and Answer for providers.
Managed care contracts in New Hampshire require that managed care organizations (MCOs) implement comprehensive care management programs that at a minimum contain certain elements, including:
The contracts require that in coordinating care MCOs “ensure that services provided to children are family driven and based on the needs of the child and the family.” Care coordination services for children are required to:
MCOs are expected to develop relationships with resources in the community, including schools and juvenile justice systems.