Table 1.

Major Dimensions of Managed Behavioral Health Care Arrangements

			Levels
Domain		Content	MCO	BHO	Provider
1	Description of managed care plan	•Parties to the contract	X	X
		•Type of Medicaid waiver or state plan amendment	X
		•Geographic areas	X	X
		•Duration of the contract	X	X
	Organizational features of the managed care plan	•Tax status	X	X
		•Profit status	X	X
		•Affiliation with a larger corporate entity	X	X
		•MCO roles under the contract	X	X
		•Contract as % of MCO business	X	X
		•Legal structures (e.g., partnerships, subcontracts)	X	X
2	Enrolled population	•Base rate of covered lives	X	X
		•% eligibility, age, & disability category	X	X
3	Benefit design, medical necessity, and utilization management	•Integration of health, MH, SA, pharmacy •Covered services (exclusions, amount, scope & duration limits, financing)	X	X
		•State hospitals and court-ordered treatment	X
		•Public sector services available outside of the managed care plan
		•Medical necessity definition & sources	X	X	X
		•Involvement of treating clinician in determinations	X	X	X
		•Clinical appeals processes	X	X	X
		•Procedures to manage utilization (e.g., prior authoriz.)
4	Payment and risk arrangements	•Financial arrangements (e.g., capitation, fee-per-episode, case rate) and % of contract dollars
		•Administrative fees	X	X	X
		•PMPM (capitation only)	X	X	X
		•Capitation rates	X	X	X
		•Risk sharing arrangements (e.g., stop-loss, risk corridor)	X	X	X
5	Composition of Provider Networks	•Types of individual providers (payment, risk, profit sharing)			X
		•Types of institutional providers (payment, risk, profit sharing)			X
		•Ratio of providers to enrollees			X
		•Safety net providers			X
		•Use of core or tier of providers			X
6	Accountability	•Performance indicators	X	X	X
		•Sanctions for non-performance	X	X	X