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​The Disease and Case Management Branch uses monitoring and oversight techniques to ensure members have access to quality services through effective disease and case management practices. This approach involves the Department for Medicaid Services, managed care organizations, providers and members. Providing members with effective disease and case management will improve quality of care which will ultimately improve overall outcomes.

The Disease and Case Management Branch staff is responsible for the following:

  • Reviewing and monitoring both managed care organization (MCO) and fee for service disease and case management programs
  • Monitoring the Early and Periodic Screening, Diagnostic and Treatment benefit that is available to Medicaid members younger than 21
  • Coordinating fair hearing requests for the denial for Medicaid services
  • Receiving and coordinating disenrollment for cause requests received from members.

Documentation