According to the ITN, these services will “assist the agency with ensuring the accuracy of and access to provider networks reported by managed care plans in addition to implementing processes that hold managed care plans accountable for maintaining adequate provider networks.”
For context, AHCA administers the Statewide Medicaid Managed Care program, which contracts with various managed care plans to provide health care and long-term care services to Medicaid recipients.
For example, a few of these contracts include managed medical assistance, long-term care and dental plans. The agency is looking for a vendor to provide the following services to monitor and enforce standards set for these plans:
- Audit and test provider networks reported and maintained by managed care plans
- Receive network access complaints from the agency’s Recipient and Provider Assistance Bureau and research and audit alleged network deficiencies to determine potential findings
- Address and monitor identified network deficiencies in managed care plans to ensure appropriate remediation
- Provide analytics, dashboards and reports of vendor findings and activities
