Included here are some other typical contract provisions that may be of interest.

Consistency with Medicaid Law

  • MCO must comply with current Medicaid handbooks and fee schedules, except where contract alters requirement set forth in handbooks and fee schedules: Florida a
  • All state Medicaid agency guidelines, policies and manuals are incorporated by reference into contract: Arizona b

Consumer Rights

  • Contract includes list of consumer rights: New York c

Enforceability of Contract

  • No third party beneficiaries to contract between MCO and state: Kansas d, New York e

Assisting Providers with Managed Care Logistics

  • For at least first 12 months of program, MCO must offer monthly education and training for providers regarding claims submission and payment processes: Florida f
  • MCO must make accommodations in claims processing systems to ease transition for LTSS providers: Texas g
  • All MCOs must used state-developed standardized method for billing LTSS providers: Texas h

Termination of Provider from Plan

  • MCO must notify consumers of provider termination at least 60 days before effective date: Florida i, Minnesota j
  • MCO must give written notice of provider termination to each member who received primary care or who is seen on regular basis by terminated provider within 15 days of termination notice: Arizona k

Workforce Development

  • MCO must conduct activities to increase number of paraprofessionals participating in LTC workforce: Arizona l
  • MCO must hire people with disabilities and be able to demonstrate what percentage of its workforce qualifies: Kansas m
  1. Fla. Contract, Atch. II, p. 39.  (back)
  2. Ariz. Contract, p. 21.  (back)
  3. N.Y. Medicaid Advantage Plus Contract, Sect. 13, p. 2-4; N.Y. Partnership Contract, App. L, p. 138.  (back)
  4. Kan. RFP, p. 129.  (back)
  5. N.Y. Medicaid Advantage Plus Contract, Sect. 23, p. 7.  (back)
  6. Fla. Contract, Atch. II, p. 81.  (back)
  7. Tex. Contract p. 8-142.  (back)
  8. Tex. Contract p. 8-142.  (back)
  9. Fla. Contract, Atch. II, p. 77.  (back)
  10. Minn. Contract, p. 60.  (back)
  11. Ariz. Contract, p. 43  (back)
  12. Ariz. Contract, p. 61.  (back)
  13. Kan. RFP, p. 90.  (back)

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