Medicaid Agencies → Delivery → Network Management

 

Network Management

 
Some key issues states may want to consider when establishing a network of National Diabetes Prevention Program (National DPP) CDC-recognized organizations include:

  • Geographic dispersion to ensure adequate access and availability of programs;
  • The data tracking processes and mechanisms to be used by the covered providers;
  • Standards for claims submission processes; etc.

 

 

Medicaid Network Access Rules

Within Medicaid, states must ensure adequate access to providers (i.e., CDC-recognized organizations).

The “equal access provision” outlined in Title 42 of the Code of Federal Regulations (CFR) requires that state Medicaid reimbursement ensures that program enrollees have the same access to care that is available to the general population (42 CFR 447.204).

Additionally, states must monitor access to care through an access monitoring review plan. “The access monitoring review plan and analysis must, at a minimum, include: The specific measures that the state uses to analyze access to care such as, but not limited to:

  • Time and distance standards,
  • Providers participating in the Medicaid program,
  • Providers with open patient panels,
  • Providers accepting new Medicaid beneficiaries,
  • Service utilization patterns,
  • Identified beneficiary needs,
  • Data on beneficiary and provider feedback and suggestions for improvement,
  • The availability of telemedicine and telehealth, and
  • Other similar measures…”. (42 CFR 447.203)

For Medicaid managed care network management considerations, see the Medicaid MCO Network Management page of the Coverage Toolkit.
 

 

Contracting with CDC-Recognized Organizations

It is important to note that meeting network adequacy standards can be an issue when CDC-recognized organizations are not uniformly available to Medicaid enrollees across the state. Online or distance learning programs may be able to be used to compensate for this.

The state Medicaid agency will outline network expectations for CDC-recognized organizations. It is important to note that even though CDC-recognized organizations have experience with meeting CDC’s Diabetes Prevention Recognition Program (DPRP) standards, many of these organizations will likely be new to the Medicaid program and may not understand Medicaid program standards and MCO contracting procedures. Additional time and/or training may be necessary to assist these organizations. To learn more about contracts between MCOs and CDC-recognized organizations, visit the Contracting page of the Coverage Toolkit.
 

 

Leveraging State Public Health Department

States may also want to consider leveraging their state public health department to help connect them with the CDC-recognized organizations in the state. Many public health organizations and agencies have been involved in initiatives related to scaling and sustaining the National DPP lifestyle change program, including delivering the program themselves in areas that do not have access to CDC-recognized organizations.

To learn about how state agencies can assess the landscape and technical assistance needs of CDC-recognized organizations, expand the capacity of the state network through support of existing and recruitment of new organizations, help organizations develop business acumen skills for successfully engaging with payers, and explore options for providing third-party or collective administrative support, visit the Building Network Capacity and Supporting CDC-Recognized Organizations page of the Coverage Toolkit.
 

Content Updated: February 26, 2021

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