3. (40 points) Use the sample managed care contract of the Illinois Department of Healthcare and Family Services (the Illinois Medicaid agency) in the following link to answer the following questions:

3. (40 points) Use the sample managed care contract of the Illinois Department of Healthcare and Family Services (the Illinois Medicaid agency) in the following link to answer the following questions:

https://www.illinois.gov/hfs/SiteCollectionDocuments/201824001MCOModelContractRev3RedLine.pdf .

A. (2 points) Identify the section of the contract that names the parties to the contract.

i. Who are the parties to the contract?

ii. Which party is the Medicaid agency and which party is the managed care plan?

B. (2 points) Which party is paying for the services in the contract?

C. (6 points) Identify the sections of the contract which describe the following payment methodologies and describe the payment methodologies:

i. the base payment methodology

ii. sanction methodology

iii. bonus methodology

D. (30 points) Chapters 8, 10 and 11, respectively, discuss improving patient safety, utilization management, and organizing for quality.

i. (9 points) Organizing for Quality


 

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