In some states, managed care organizations (MCOs) are required to provide consumers with advocacy assistance.
Representation in Individual Matters
- MCO must provide consumer advocate to assist consumers in navigating MCO’s system: Tennessee a, Texas b
- MCO must have Member Rights Specialist to assist with issues relating to care management and service provision, including assistance with grievances and appeals: Wisconsin c
- MCO must provide advocate to assist consumers with grievance and appeals processes: Kansas d
Representation in Systematic Matters
- MCO must provide consumer advocate to represent consumers’ interests in designing and monitoring MCO’s systems: Tennessee e
- MCO’s consumer advocate must have authority to make recommendations to state: Tennessee f
- MCO must have Member Rights Specialist to assist in assuring quality services throughout MCO: Wisconsin g