Disease and Case Management Branch


​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​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 of Medicaid services
  • Receiving and coordinating disenrollment for cause requests received from members.​

What's New

CMS health care quality core set chart packs

Each year the Centers for Medicare and Medicaid Services publishes core measures of the quality-of-care and health outcomes for adults participating in Medicaid and children enrolled in the Medicaid Children’s Health Insurance Program.  Please view the: