CROSSWALK: Abbreviated MCO Surveys

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Updated grammer and formatting of questions for easier
understanding.

Rev

To make it easier for repondent to complete the survey.
Updated grammar, sentence structure and formatting for
easier understanding.

Spelled out acroynms for easier understanding.

Rev

To make it easier for repondent to complete the survey by
Decrease work burden for respondents by 5 minutes.
identifying acroyms.

Opening Introduction to survey: Clarified what an Abbeviated MCO
is per OGC: While states have the ability to exclude (or “carve
out”) subsets of Medicaid benefits from their MCO contracts, it is
typical that an MCO that does not cover the pharmacy benefit (that
is, pay for covered outpatient drugs (CODs) dispensed from a
pharmacy) will still be responsible for covering CODs administered
in a doctor’s office and/or outpatient hospital or clinic.

Rev

Clarification of what an Abbreviatd MCO is

Opening Introduction to survey: CMS does not edit State responses;
therefore, what is submitted will be what is posted on Medicaid.gov.
This material is also utilized for composing the annual report to
Congress.

Add

Incorporated statement in introduction to increase
respondent understanding that their responses will not be No burden change
altered when reporting out.

Section I, Demographics - removed telephone number

Rev

Removed telephone number as not needed and replaced
with Postion Title

No burden change.

Section IV. FWA, A. Lock-in or PRR, Question 1.

Add

The "No" response requires an explanation.

Increase work burden for respondents by 10 min.

Section IV. FWA, A. Lock-in or PRR - Question 5. Does your
MCO have a documented process in place that identifies and/or
prevents potential FWA of controlled drugs by beneficiaries?

Del

Deleted duplicate question.

Decrease work burden for respondents by 5 min.

Section IV. FWA, A. Added Question - Briefly explain the MCOs
objectives and scope of responsibility between DUR and SUR
functions as they relate to FWA. Additionally, explain how the
MCO maintains separation between fraud and abuse and
educational activities. (Character limit 1000)

Add

Added question to maintain oversight to requirements

Increase work burden for respondents by 20 min.

Section IV. FWA, B. PDMP - Section reorganized, mandatory
reporting as of FFY 2023 data.

Rev

To more efficiently follow the flow of Section 5042 of the
Increase work burden for respondents by 15 min.
SUPPORT Act mandatory DUR questions.

Section IV. FWA, C. Opioids - Questions 3, 4 and 5 restructured text
for easier responses.

Rev

To more efficiently allow respondents to respond to
questions.

No burden change

Section IV. FWA, C. Opioids - Question 7 - Updated to current
reference

Rev

Clinical Practice Guideline for Prescribing Opioids for
Pain reference updated from 2016 to 2022

No burden change.

Section IV. FWA, G. Psychotropic Medication for Children Questions 1, 2 and 3 restructured to allow for an additional response Covered through the FFS benefit .

Rev

This additional response will allow for less burden in
completing follow up questions if not Covered through
the FFS benefit .

Decrease work burden for respondents of 30 min.

Section IV. FWA, G. Psychotropic Medication for Children Questions 1.a., 2.a. and 3.a.

Rev

Updated question for clarity and understanding

No burden change.

Section IV. FWA, G. Psychotropic Medication - Questions 2 and 3
added

Add

Added to comply with 2024 CAA Section 203
requirement
Total:

Decrease work burden for respondants by 5 minutes.

No burden change

Increase work burden for respondents by 20 min.
Increase 20 min workload