Health Care Buyers Now Have 10 Sample Documents
to Use in Drafting Managed Care Agreements

Buyers of managed care services will soon have access to two new documents they may use in drafting agreements with managed care organizations for the delivery of health care services.

The two technical assistance documents – called “purchasing specifications” – provide sample language for contracts covering services for people experiencing homelessness and standards in access to health care. Eight documents completed earlier cover the purchase of services dealing with pediatrics, HIV/AIDS, immunizations, tuberculosis, sexually transmitted diseases, dental care, reproductive health services and the prevention of lead poisoning. All but the access to health care document can be accessed on the Internet at: http://www.gwu.edu/~chsrp. The access document is expected to be posted shortly.

Key users of the sample documents will likely be public sector purchasers – such as state Medicaid and public health agencies – and private-sector employers and employer-purchasing coalitions. Purchasers may decide to use the specifications in their entirety or select sections of the specifications and integrate those parts into other purchasing documents.

The sample access to care agreement includes language on such topics such as travel time and distance standards to provider sites, appointment and wait times, and provider-patient ratios. The specifications on persons experiencing homelessness include sample language on case management, enrollment, and provider selection.

All of the purchasing specifications have been developed by George Washington University’s Center for Health Services Research and Policy. Technical expertise and funding for the two latest documents were provided by HRSA; previous purchasing specifications have been funded by HRSA, the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, and foundations. Authors based language used in the specifications on federal Medicaid law; formal guidelines issued by a government agency, professional society or an impartial deliberative entity; and the judgment of experts in the particular field.

Additional purchasing specifications on cultural competency, memoranda of understanding between managed care organizations and public health departments, and services for adults with mental illness and addiction disorders are expected to be completed and posted on the Web later this year.

HRSA’s support of the development of the purchasing specifications stems from its belief that the documents will help improve the quality of medical care for the low-income patients served by agency-funded programs.

More information on the sample specification documents may be obtained from HRSA’s Center for Managed Care at 301-443-1550 or from Jeff Levi, Ph.D., at GWU’s Center for Health Services Research and Policy at 202-530-2363.

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