Advocacy Assistance Provided By Managed Care Organizations

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
  1. Tenn. Contract, p. 368.  (back)
  2. Tex. Contract, pp.  8-115 — 8-116.  (back)
  3. Wis. Contract, pp. 140, 155-56.  (back)
  4. Kan. RFP, Atch. D., pp. 3, 10.  (back)
  5. Tenn. Contract, p. 368.  (back)
  6. Tenn. Contract, p. 368.  (back)
  7. Wis. Contract, p. 140.  (back)

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