Medicaid MCOs → Contracting → Contracting with CDC-Recognized Organizations
Contracting with CDC-Recognized Organizations
Contracts between Medicaid managed care organizations (MCOs) and CDC-recognized organizations should outline expectations between the parties and include National Diabetes Prevention Program (National DPP) lifestyle change program requirements. CDC-recognized organizations are those that have demonstrated the ability to effectively deliver the evidence-based lifestyle change program with quality and fidelity as described in CDC’s Diabetes Prevention Recognition Program (DPRP) Standards. For more information, see the Standards for CDC Recognition on CDC’s website.
The contracting process can be unfamiliar and daunting for MCOs and CDC-recognized organizations alike. The Tips for Contracting with Medicaid Managed Care Organizations document below offers helpful guidance on approaching the process with patience, building a relationship, pitching to MCOs, speaking an MCOs language, and taking advantage of MCO resources.
Some common elements recommended for inclusion in contracts between MCOs and CDC-recognized organizations include:
- Program eligibility requirements
- Description of covered services
- Program promotion and enrollment expectations
- Reimbursement schedule and billing codes (if applicable)
- CDC-recognition requirements
- Data sharing and reporting expectations
- Patient data confidentiality
- State-specific requirements, where applicable
The Prospective Contract Components document below includes language related to these common contract elements. It is intended to be educational in nature, providing elements to consider when contracting between a Medicaid MCO payer (Payer) and a CDC-recognized organization (Organization). It does not constitute legal advice and does not substitute for legal advice when crafting an agreement. Entities should consult with an attorney or contract specialist when establishing such an agreement.
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Other Considerations
As an alternative to contracting directly with CDC-recognized organizations, some MCOs may choose to contract with a third-party organization to administer the lifestyle change program. Third-party organizations can work with MCOs to establish a network of CDC-recognized organizations, work with health care providers, and recruit eligible individuals into the program. Medicaid MCOs can tap into a network of CDC-recognized organizations called an Umbrella Hub Arrangement.
It is also important to note that even though CDC-recognized organizations have experience with meeting CDC’s 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.
