Medicaid Managed Care Improvement Act of 1991

Summary

Medicaid Managed Care Improvement Act of 1991 - Amends title XIX (Medicaid) of the Social Security Act to provide for State Medicaid coverage of coordinated care. Defines "coordinated care" as programs operated by any qualifying public or private health maintenance organization or primary care case management program (PCCMP). Revises provisions governing State plans for medical assistance under Medicaid to: (1) eliminate the requirement that Medicare (title XVIII of the Social Security Act) and Medicaid beneficiaries constitute less than 75 percent of the membership of any prepaid medical provider; (2) permit States to mandate enrollment of eligible individuals, provided the individuals have of choice of two or more plans, a choice between enrolling in a plan or in a PCCMP, or a choice among physicians to the extent that two-thirds of the physicians in the area particpate in the plan or system; and (3) require that a plan provide for implementation of an internal quality assurance program containing specified elements. Requires a State contracting for coordinated care: (1) with a PCCMP or a plan, to provide for specified quality assurance activities, including a State-operated enrollee grievance procedure and a survey and analysis of enrollee satisfaction; and (2) with a plan, to provide for an independent review of each plan's quality assurance activities by an organization external to the State. Authorizes the Secretary of Health and Human Services to provide for continuation of any operating managed care program without granting additional waivers if the program is successful in assuring quality and containing costs.

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2 official files

• Introduced in Senate (text)

  Introduced in Senate · EN

  ViewDownloadOpen at official source

• Introduced in Senate

  summary · EN · 26 November 1991

  Open at official source

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