SPECIALIZED MANAGED CARE FOR CHILDREN AND YOUTH

This contract is for specialized managed care services for children and youth in West Virginia. The contract is between the West Virginia Department of Human Services, Bureau for Medical Services (BMS), and Aetna Better Health of West Virginia. The contract provides for comprehensive health services, including medical, dental, and behavioral health services, to Medicaid enrollees who are in foster care, receiving adoption assistance, or are youth formerly in foster care up to age 26. The contract has a term of one year, with the option to renew for two additional successive one-year periods. The contract includes provisions for capitation payments, network requirements, and quality assessment and performance improvement. Some key points of this contract include: • The contract provides for comprehensive health services, including medical, dental, and behavioral health services. • The contract has a term of one year, with the option to renew for two additional successive one-year periods. • The contract includes provisions for capitation payments, network requirements, and quality assessment and performance improvement. • The contract requires the MCO to provide care coordination, case management, and disease management services to enrollees. • The contract includes provisions for marketing and enrollment, including requirements for marketing materials and enrollment processes. • The contract requires the MCO to provide reports and data to the Department, including reports on enrollment, claims, and quality metrics.