About Medicaid
Title XIX of the Social Security Act is a federal-state matching entitlement program which provides medical assistance for certain individuals and families with low incomes and resources. This program, known as Medicaid, is a jointly funded cooperative venture between the Federal and State governments. Within a broad range of guidelines provided by the Federal government, each state establishes its own standards, determines the scope of services and payments, and administers the program. Thus, Medicaid programs and requirements vary considerably from state to state and within each state over time.
RESOURCES
After understanding your objective, our consultants
begin with a thorough analysis of the regulations guiding your quality
and utilization programs. This generally includes a combination of the
state-specific QISMC standards and related regulations. Many of the
tools and templates used for commercial managed care plans are easily
modified to fit the Medicaid environment. Many organizations implementing
QISMC are also implementing commercial accreditation standards. We can
assist with initial design through implementation and regulatory reporting
of your QISMC program.
Our Services
Syntro offers a menu of services and tools, which are adapted to fit
your needs. After understanding your objectives and internal resources,
we assess your organization's needs and help you determine areas currently
in compliance, as well as gaps with each standard requirement.
The Assessment
Your assessment includes reviewing key plan documents, evaluating core
processes, auditing files and interviewing staff responsible for managing
and implementing standards. We complete the initial assessment using
the version of the surveyor guidelines and applicable materials that
you will be accredited under.
If desired, you may request an assessment against multiple sets of standards,
for example, Medicaid and Medicare regulations, JCAHO and URAC.
Establish Priorities
The assessment results help you establish priorities and determine areas
needing the highest degree of focus. You receive from us an action plan
for the gaps, written in a project-plan format that you can use for
management. We help you work through the variables necessary in setting
the priorities that are right for your organization.
Develop a Plan
Your action plan serves as the basis for developing a full plan for
implementation of the standards and/or survey preparation. The plan
is a living document that you update and modify.
Tools and Templates
You may desire other resources that make implementation and survey preparation
easy and minimize struggle and stress. Our tools library
(click here
to review) provides tools to help guide implementation as well as sample
program documents, and policy and procedure templates. We have done
the research, analysis, and organized all information into easy-to-use
guidelines and templates, saving you many hours of time and money. These
tools are based on years of experience in the field and as surveyors.
Other Services
We tailor our services to match the needs and desires of the organization.
Services can range from an initial evaluation and report, to quarterly
site visits with intermittent conference calls and off-site document
review, to onsite project management. (click here to access information
on Syntro consulting services).
