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Federal and state governments should consider the performance of managed care contractors and providers before entering into contracts. They should:
Federal and state governments should ensure that beneficiaries enrolled in MCOs for Medicare, Medicaid, or both are allowed to change plans or return to fee-for-service (FFS) arrangements at any ti
When dual-eligibles are enrolled in managed care for Medicaid benefits, Medicare benefits, or both, state and federal governments must ensure that all statutorily required benefits are covered by t
States should guarantee that dual-eligibles and, as appropriate, their family caregivers or representatives receive information about all health and LTSS options for which the beneficiary is eligib
To the extent possible, states and the federal government should ensure that all MCOs honor beneficiaries’ desire to maintain a continuous relationship with a high-quality provider or health plan.
States and the federal government should ensure that MCOs (including those participating in duals demonstrations) seek to improve the quality and value of care for dual-eligibles.
States, in partnership with the federal government, must have sufficient capacity to monitor MCO compliance effectively and take corrective action where necessary.