Medicaid Managed Care - U.S. Senate Special Committee on Aging

More documents

Recommendations

Info

AP Ag. 0065(0 og. qP e8 y. d-ftd 04b8W.00 Sa Pad W0146 dh0086 6*650( 160 Aoe . to- 200% d P-ly, At P. h-i ala -, hWa I d.a. M"W C-W8( a_ 00.dka-I S1d y MMF) t-odO HiPWk m u fl QA. U 0. h.4t ha. -Wld dlt Wax CdWW mu
161 Td b 3 Phy9(005 .- end Men"' HootS 005tl0,l0 tor Pa5,.it, Trt .h P.g.Wt end Foo-I-S8,v SytO Gtn. W.e"g b Age 0nd P-nny Stl, ptry H6b00095H^h A.non S9o, C gsWt _I CohgW, %t A..op S . C b.D"Pft Ct.g., %t No. _ 4 4 tt% CIS Wo. so leo tt. 4y y4 99% Cis 0w5 0 T~so.W S.M. osol Pt.ot(HMO) 2235 i003 f00 t.4 -3.0 -&I -3.8tW-2.2 -0.350-1.9 29 30 5S -01.5 5s ts 15 405 47.9 1.1 12 0.301.9 0.02.24 15 14 93 e0113 94 22 22 F.r- Ag. ia I w 45.2 -3.0 -4.2 W1.9 27 57 ts 00.5.5 IIX.00. 090 50 -0.402.4 lt a3 21 *elay a22 .s35 -5.91 -7.050 -.. 36 53 5 5031 07 -0.5 1.9 15 65 20 Noroltny 1413 45.7 -t.9 -2.9s0-0.9 25 5o 17 7.7 1.3 0.31o2.3 tO 53 22 PFdy w.5 Po~y 499 00.4 -3.5 -5.20-2.0 33 XO 5 157 07 0.7 -1.1 Wo25 97 '.1.6 00 23 N0.00y 1740 45a 2 -2.9 -3.715-2A 27 5a is 4a9 12 0.42.0 55 64 21 M 'KMO hOdm. h00h Pd n 5 hDllh) htt0. s ongo S- u- o -*- tc d W0 a, l 0gn.000.0 0-J .00 o c 0 -y- 5.5 - fM,. Tt. -ys ch09 lor Why5 h0.D tnT- X*lerCMilleS Wch c -gID& n- ts~~~~~~r_ *55 05. 55% 000550.5,0Onolh ,snot (CO) 05 iWn baW Dr -t wb1-a M5 00,05 I *05ft. 0N5 le llshl M P-go hne- td Dl" br .. ;: raiO: .- n 1-D n - - e ra t by 9 -Ih nw -w*cn 0 (Pc.05 ) M. Wfllg pair .1 V1..01. Tobbl 4.--PhyW . Ml Heels, 00s in Pn 0aluld F-Sor.Su. Syeteto Wo, Eldedy 0n0 Non0Idedy P0. PhY.900 Ho.fth- 1101 H00h A... Son Co. 055 Ch . %t A...W Scor_- 9 C h50oslll np-g, %t No. P0)- (SE)n-5% 4Sy Cll W- S. 13. 19-11- (SE) At 99% C15 W- Sun 6n0 `dPy`*J (HMO) 340 03(0.7) -7.0 -8.995-5.2 54 37 9 501(08) 5.3 -0.5M3.1 4 50 29 F w.- 478 43.5(0.7) -5s -0.6D-34 20 93 9 505(0.8) 0.2 -5.05ZO 50 7 53 0. 2 N55505y 1413 , . 3 00.20 Ps.g Wd(HMO) 727 4.(0.5) -1.2 -2.95002 23 52 9 4*59(0.) 1.5 0.12.9 12 a8 20 F..-*s.eo.so 000 059)0) -2.0 2 -3.050-5.0 3 -0.29 Z9 57 5 55 45(05)075020 59(0.5) TWa Wi q-W of dih nnw b ou b.!- rn1n tdty VD Wft* Oz, ,Z~55- IF. .. C75.9 *50t~ ~ o to h .nsogriph. 0Chtn C . amt dF taot. Th. -y..t dngV. 0 tu ph i.D th (bu. noW oontt hs..hh) td-S. .t0. t0 t *-- &utaP to- - M Mh-otrtDt o t.s Wht,, b n2ha th. rpwDt t- ch n1p -u cWa - M ft tpa ct n fn (FF0) 0_00 0a SIt U. 95% fsfn ata isltllo (Cl) d0.. n ktd .0, Ut-, -n W ft h.WM dcg t Pn(H Wt , as, . (HMO) 9-0 *ant f * by e.0.0 (P0os). cn ttubt - *P..O t ..Op .ot ever, the categorical analyses called at- tal health than nonelderly at baseline and FFS plans were significantly diftention to substantial variation in out- (P
Page 1 and 2:
S. HRG. 105-262 MEDICAID MANAGED CA
Page 3 and 4:
CONTENTS PEOPLE WITH SPECIAL NEEDS,
Page 5 and 6:
V Bazelon Center for Mental Health
Page 7 and 8:
2 also apparent that structuring a
Page 9 and 10:
4 through the doors when somebody o
Page 11 and 12:
6 delay the onset of secondary disa
Page 13 and 14:
8 BRIEFING FOR CONGRESSIONAL STAFF
Page 15 and 16:
10 obstetric and gynecological serv
Page 17 and 18:
JlSAes CRi. E CalD5Vilb J~iiiLi uls
Page 19 and 20:
14 people with disabilities and spe
Page 21 and 22:
16 and prospective enrollees the pl
Page 23 and 24:
18 by the disorder. In fact, schizo
Page 25 and 26:
20 r_ 06/23/1997 16: 03 7836845968
Page 27 and 28:
22 Kathy. STATEMENT OF KATHLEEN H.
Page 29 and 30:
24 even lead to an improvement-but
Page 31 and 32:
26 MANAGED CARE AND LONG TERM T h e
Page 33 and 34:
Consortium for C. 20249&Oid Citizen
Page 35 and 36:
30 11 Managed care
Page 37 and 38:
Strong Oualitv Assurance Measures 3
Page 39 and 40:
NATIONAL ASSOCIATION 34 DEVELOPMENT
Page 41 and 42:
36 Mrs. M.'s care plan is quite com
Page 43 and 44:
38 nurses and social workers be ava
Page 45 and 46:
40 EXPENDITURES FOR NURSING HOMES S
Page 47 and 48:
REQUIRES THE SKILL OF A HIGHLY TRAI
Page 49 and 50:
44 ALZHEIMER'S DISEASE AND RELATED
Page 51 and 52:
46 WITHOUT ADEQUATE RESPITE CARE, I
Page 53 and 54:
48 PROBLEM FOR PEOPLE SUFFERING FRO
Page 55 and 56:
50 Ms. CHRISTENSEN. Thank you. Don.
Page 57 and 58:
52 it will eradicate the virus. Man
Page 59 and 60:
I 54 Today I participate in a state
Page 61 and 62:
56 Ms. CHRISTENSEN. Thank you. [Ina
Page 63 and 64:
58 rather than to community-based s
Page 65 and 66:
60 now has to start looking at thin
Page 67 and 68:
62 plan for that matter, can measur
Page 69 and 70:
64 ual is getting state-of-the-art
Page 71 and 72:
66 a larger population of people wi
Page 73 and 74:
68 of recovery or rehabilitation th
Page 75 and 76:
70 are entitled to renew their pres
Page 77 and 78:
72 point and say that Patsy comes f
Page 79 and 80:
74 .The WASHNTND MEDICAL CENTER CEN
Page 81 and 82:
76 exceptions - have largely based
Page 83 and 84:
78 Plans have not shown a willingne
Page 85 and 86:
eligible people and for the program
Page 87 and 88:
Table l.b Selected Provisions Relat
Page 89 and 90:
VariiaIioils in rownlr-c1t language
Page 91 and 92:
Variations in cbonIlrlcl Is1sgu;age
Page 94 and 95:
Executive Summary 1. Setting the Co
Page 96 and 97:
age, which pays for those M
Page 98 and 99:
This consensus building exercise is
Page 100 and 101:
95 Ms. CHRISTENSEN. I'm going to in
Page 102 and 103:
97 abled population will all need s
Page 104 and 105:
5601 Smetua- Drive PO. r,. 9310 Mmn
Page 106 and 107:
101 Our experience with the AFDC po
Page 108 and 109:
103 I have tried to list both the o
Page 110 and 111:
105 BACKGROUND INFORMATION PATRICIA
Page 112 and 113:
164 Communicating the Quality Messa
Page 114 and 115: 166 Communicating the Quality Messa
Page 124 and 125: 119 Dr. SCANLON. In this series of
Page 126 and 127: 121 lation in managed care in Minne
Page 128 and 129: 123 thing, because you will have va
Page 130 and 131: 125 If we develop them now around e
Page 132 and 133: 127 I think those are the things yo
Page 134 and 135: 130 to use, and they will be collec
Page 138 and 139: 134 unlikely though that these futu
Page 140 and 141: 136 While we are in the midst of th
Page 142 and 143: 138 Center for Health Program Devel
Page 144 and 145: 140 ('enter for Hearlth Proeram Dev
Page 150 and 151: 146 If More is Better, Cost Contain
Page 152 and 153: 148 ANALYSIS OF OUTCOMES SF-36 phys
Page 154 and 155: 150 4-Year Physical Health Outcomes
Page 156 and 157: 152 MAJOR FINDINGS -1 PHYSICAL DECL
Page 158 and 159: 154 INTERPRETATION OF RESULTS * Equ
Page 160 and 161: 156 Additional Information is on th
Page 162 and 163: order) were followed. Samplingpatie
Page 166 and 167: 162 Tlbb. 5-Plso91 A& MerohJ H89t0
Page 168 and 169: and chest pain sufficient to requir
Page 170 and 171: 166 Quality Special</strong
Page 172 and 173: THE STATE OF THE STATES TUESDAY, JU
Page 174 and 175: 171 a little bit about some of the
Page 176 and 177: 173 gatekeeper, and we also wondere
Page 178 and 179: 175 Maryland ought to submit that w
Page 180 and 181: 177 fined by us in our regulations,
Page 182 and 183: 179 To get to that kind of situatio
Page 184 and 185: 181 Outline of Presentation for Dep
Page 186 and 187: 183 B. Approaches to Ensure Quality
Page 188 and 189: 185 * Holds MCOs accountable for qu
Page 190 and 191: 187 HealthChoice and People with <s
Page 192 and 193: 189 HealthChoice and People with <s
Page 194 and 195: 191 Take these three steps to choos
Page 196 and 197: 193 Call 1-800-888-1965 if you are
Page 198 and 199: IF YOU HAVE HIV/AIDS 195 MCO staff
Page 200 and 201: 197 * Refer you to a medical specia
Page 202 and 203: *pV 199 SERVICES FOR CHILDREN IN ST
Page 204 and 205: 201 Ms. CHRISTENSEN. Thank you. Go
Page 206 and 207: 203 We implement these QI goals thr
Page 208 and 209: 205 Medicaid recip
Page 210 and 211: 207 My name is Peggy Bartels. I am
Page 212 and 213: 209 At the forefront of Wisconsin's
Page 214 and 215:
211 Finally, we believe that high q
Page 216 and 217:
213 WISCONSIN DEPARTMENT OF HEALTH
Page 218 and 219:
2 SELECTED INDICATORS Access to <st
Page 220 and 221:
Mental Health 217 * HMOs reported f
Page 222 and 223:
'Nisconsin Medicaid</strong
Page 224 and 225:
Program for Program Chareolorletice
Page 226 and 227:
Primary Program AFDC/H8 Provlqar Ch
Page 228 and 229:
225 Children Come First of Dane Cou
Page 230 and 231:
227 Wraparound Milwaukee saving dol
Page 232 and 233:
229 Another positive outcome of the
Page 234 and 235:
231 AltDoughl Nkvie' iniCil costs i
Page 236 and 237:
233 CCE's staff consist of a variet
Page 238 and 239:
235 Al the cturent time, there is n
Page 240 and 241:
237 PACE/Partnership programs guide
Page 242 and 243:
239 necessarily relevant to the AFD
Page 244 and 245:
241 about including these specialty
Page 246 and 247:
EXECUTIVE COMMITTEE Ct-u B.1r- M.mb
Page 248 and 249:
Considerations: 245 Enrolling <stro
Page 250 and 251:
247 Medicaid <stro
Page 252 and 253:
a. some counties 249 b. mandatory e
Page 254 and 255:
251 counties as well-of managed car
Page 256 and 257:
253 In other States devolution is m
Page 258 and 259:
255 /-LCenter for Health Ca
Page 260 and 261:
257 Forums on Managed</stro
Page 262 and 263:
259 Medicaid Carve
Page 264 and 265:
261 So I view Medicaid</str
Page 266 and 267:
264 Medicaid: Spen
Page 268 and 269:
266 a 50 percent match. 2 Since 198
Page 270 and 271:
268 If enrollment of eligible indiv
Page 272 and 273:
270 drugs, ICF services, and optome
Page 274 and 275:
272 Table 20-1. Medicaid</s
Page 276 and 277:
274 The slowdown in spending after
Page 278 and 279:
276 Section 1115 Demonstration Waiv
Page 280 and 281:
278 primary care case management ar
Page 282 and 283:
280 Table 20-2. Enrollment in <stro
Page 284 and 285:
282 / Figure 20-6. Enrollment Growt
Page 286 and 287:
284 Marnaged-care growth at the sta
Page 288 and 289:
286 Figure 20-9. Enrollment in Risk
Page 290 and 291:
288 The extent of problems in repor
Page 292 and 293:
290 plans (PPRC 1996). In other are
Page 294 and 295:
292 There appears to be a clear tre
Page 296 and 297:
Enrollment and Disenrollment Polici
Page 298 and 299:
296 individually with plans over ra
Page 300 and 301:
298 Health Care Fi
Page 302 and 303:
Medicaid M
Page 304 and 305:
Support & Services Office 120 W. Tw
Page 306 and 307:
INTRODUCTION 304 Presently, nearly
Page 308 and 309:
306 more mandatory services. Full-r
Page 310 and 311:
308 the ability of beneficiaries to
Page 312 and 313:
310 managed care also requires the
Page 314 and 315:
312 condition period. Such requirem
Page 316 and 317:
314 If a state contracts with or in
Page 318 and 319:
Appendix A State Activity* 316 Many
Page 320 and 321:
GA { I ~United States (3 Mu General
Page 322 and 323:
Results in Brief E.. - 320
Page 324 and 325:
Significant Efforts Needed to Ensur
Page 326 and 327:
Recommendations Agency Comments E-d
Page 328 and 329:
cow 326 Chapter 4 Traditional Rate-
Page 330 and 331:
Chapter I Background 328 Me
Page 332 and 333:
ovapt I 330 the option of extending
Page 334 and 335:
Federal Requirements Govern State U
Page 336 and 337:
Table 1.2: Comparison of Ma
Page 338 and 339:
Objectives, Scope, and Methodology
Page 340 and 341:
338 Chapter 2 States Are Moving Tow
Page 342 and 343:
Table 21 nEnollmen of Disabled Bene
Page 344 and 345:
342 chona Se. As To~ed Id C"fn, Dai
Page 346 and 347:
Table a& Eabent to Which 17 State I
Page 348 and 349:
346 So A- hbydf TSo -d Cam fo DIbbi
Page 350 and 351:
Table 2.5: Extent to Which 17 State
Page 352 and 353:
350 8t" Age Bowi T-Mar 11 Cue fRa D
Page 354 and 355:
352 C".Pt a Q...itA- Efl~t. . - C f
Page 356 and 357:
Addressing Concerns Through Enrollm
Page 358 and 359:
Assignment Active Management of a D
Page 360 and 361:
358 fo.V D Axd B ref .Ak,.d - CC-e
Page 362 and 363:
Targeted Quality-of-Care</s
Page 364 and 365:
Encounter Data Analysis Shows Poten
Page 366 and 367:
364 Chapter 4 Risk-Adjusted Rates a
Page 368 and 369:
366 Cu.pd 4 Rk-A4tAjLd Row Ad RIASW
Page 370 and 371:
States Could Experience Adverse Sel
Page 372 and 373:
370 Ckspt. 4 JUek-Mtod Rate Wd HIa
Page 374 and 375:
372 Ch.piWr 4 JU-i.k.d Row md RJAk-
Page 376 and 377:
374 Coob,, 4 RkikAdjned Rtr -d Rub-
Page 378 and 379:
376 rued R.I. . 2".shBd c- provider
Page 380 and 381:
378 c-5 Obh- .. I, Co.eWda, ad CHe
Page 382 and 383:
380 Ob-e-eU-o, Co-ded, end C-ost pr
Page 384 and 385:
382 United States General Accountin
Page 386 and 387:
Results in Brief B-Z70335 384 manag
Page 388 and 389:
B-2Kn0 386 assess service utilizati
Page 390 and 391:
Table 1: Characteristics of <strong
Page 392 and 393:
B-27035 390 numbers of patients. In
Page 394 and 395:
B-270335 392 number of primary care
Page 396 and 397:
B-Z7Oa33 394 developed on the premi
Page 398 and 399:
States Challenged to Develop Effect
Page 400 and 401:
B-270335 398 that beneficiary use o
Page 402 and 403:
B.270335 400 of the care provided a
Page 404 and 405:
States Could Learn More From Improv
Page 406 and 407:
Targeted Analyses of Grievance Data
Page 408 and 409:
Observations Agency Comments and Ou
Page 410 and 411:
B-270335 408 Finally, the experts w
Page 412 and 413:
410 Appendix I Scope and Methodolog
Page 414 and 415:
- I 412 App-edU I Sw Wd Methodology
Page 416 and 417:
414 AppeAdt U Fedo.I aod Stt. Ove0s
Page 418 and 419:
416 Appendix III Major Contributors
Page 420 and 421:
GAO July 1996 GAO/HEHS-96-120 418 U
Page 422 and 423:
B-26632 420 family home, rather tha
Page 424 and 425:
Background 1-206320 422 traditional
Page 426 and 427:
States Use Waivers to Expand and Ch
Page 428 and 429:
84=20 426 Figure 1: Staftes Use of
Page 430 and 431:
B-266320 428 began the 1990s with s
Page 432 and 433:
B26320 430 variety of other service
Page 434 and 435:
Enrollment Caps and Management Prac
Page 436 and 437:
Change in Federal Rule Could Result
Page 438 and 439:
States Are Introducing Innovations
Page 440 and 441:
B-nato 438 offered and the means fo
Page 442 and 443:
440 We are sending copies of this r
Page 444 and 445:
C-m 442 Table 2: Changes in Number
Page 446 and 447:
444 App-ar I So-p and Mraodsogo ent
Page 448 and 449:
446 Appendix H Medicaid</st
Page 450 and 451:
448 App-di. f M~I Wd., _. So 4 Of0
Page 452 and 453:
450 App-.i. il _-.1 - Desd s UCFVA'
Page 454 and 455:
452 Apeadls mn Stadad Seee - Defind
Page 456 and 457:
454 Appedi. M St.d.ed Se&ee s Dneoe
Page 458 and 459:
Chore 456 Am..& IV LAO n.Gd .Mt. ,
Page 460 and 461:
Occupational Therapy and Assessment
Page 462 and 463:
Psychological Services Provider Typ
Page 464 and 465:
462 AWppdi IV U-e, Cotfi-, E d Othe
Page 466 and 467:
Licensure/Registration Other Standa
Page 468 and 469:
466 United States General Accountin
Page 470 and 471:
Results in Brief B-276078 468 care
Page 472 and 473:
B-270078 470 Medi-Cal was implement
Page 474 and 475:
_.27_7 Tab 1: Mad-C Eiglbli and Enr
Page 476 and 477:
~~- - o~~BZ760?S 474 I J I the enro
Page 478 and 479:
B.276078 476 delaying the contracti
Page 480 and 481:
State's Education Process Has Not R
Page 482 and 483:
B.276078 480 and thereby supplement
Page 484 and 485:
Weaknesses in State Management of t
Page 486 and 487:
B-276078 484 standards can provide
Page 488 and 489:
Insufficient Communication and Invo
Page 490 and 491:
Some Safety-Net Providers Are Encou
Page 492 and 493:
Conclusions B-276D78 490 Safety-net
Page 494 and 495:
B-270078 492 current enrollment bro
Page 496 and 497:
Contents Letter 494 Appendix 30 Sco
Page 498 and 499:
(1115) oPP. -.M.taoy 496 oversight
Page 500 and 501:
498 ACKNOWLEDGEMENTS This Volume of
Page 502 and 503:
500 Is Lock-in to a Managed
Page 504 and 505:
502 Plan and Provider Issues ......
Page 506 and 507:
504 Chapter 1 Program Design Issues
Page 508 and 509:
506 Other studies attest to improve
Page 510 and 511:
508 Will the Program Be Voluntary o
Page 512 and 513:
510 additional option for people wi
Page 514 and 515:
512 contractor collect spenddown pa
Page 516 and 517:
514 Option A is still quite rare. P
Page 518 and 519:
516 experience with special populat
Page 520 and 521:
518 particularly on a full risk bas
Page 522 and 523:
520 Dual eligibility raises a disti
Page 524 and 525:
522 special populations, and states
Page 526 and 527:
524 Chapter 2 Care
Page 528 and 529:
526 settings. Finally, plans that s
Page 530 and 531:
5281 needs. For example, women who
Page 532 and 533:
530 Oregon's rules require that pla
Page 534 and 535:
532 beneficiaries on July 1, 1997.
Page 536 and 537:
534 facility's delivery, dosage, an
Page 538 and 539:
536 * Strategies for measuring netw
Page 540 and 541:
538. arrangements with traditional
Page 542 and 543:
540 community based or well elders.
Page 544 and 545:
542 Finally, coordination for vulne
Page 546 and 547:
544 Care Coordinat
Page 548 and 549:
546 home health agency developed a
Page 550 and 551:
548 develop a case management syste
Page 552 and 553:
550 Coordinating services is compli
Page 554 and 555:
Highlights 552 Effective care coord
Page 556 and 557:
554 beneficiaries that belong to th
Page 558 and 559:
556 services when needed. This is t
Page 560 and 561:
558 federal government and not at s
Page 562 and 563:
560 cannot enroll a person in a Med
Page 564 and 565:
562 Medicare members are not typica
Page 566 and 567:
564 Regence HMO Oregon staff noted
Page 568 and 569:
566 community based organizations t
Page 570 and 571:
568 Although technical advice for c
Page 572 and 573:
570 Risk pools are usually used to
Page 574 and 575:
572 Internal Quality Program Standa
Page 576 and 577:
574 enrollee utilization patterns,
Page 578 and 579:
576 that the overall prevalence of
Page 580 and 581:
578 HMOs with risk contracts must h
Page 582 and 583:
580 Summary As Medicaid</st
Page 584 and 585:
582 Chapter 3 Medicaid</str
Page 586 and 587:
584 carve-out approach: - improves
Page 588 and 589:
586 Coordinating Medical and Non-Me
Page 590 and 591:
588 Oregon,8 program planners origi
Page 592 and 593:
590 Medicaid syste
Page 594 and 595:
592 Oversight/Monitoring Quality De
Page 596 and 597:
594 with family and friends, contac
Page 598 and 599:
596 * The type(s) of data necessary
Page 600 and 601:
598 * Specificity of desired result
Page 602 and 603:
600 Initiatives under way may prove
Page 604 and 605:
602 a estring the services authoriz
Page 606 and 607:
604 Development of appropriate plan
Page 608 and 609:
606 OFFICE OF INSPECTOR GENERAL The
Page 610 and 611:
Establishing core developmental tea
Page 612 and 613:
610 taken into account considerable
Page 614 and 615:
PURPOSE 612 INTRODUCTION Our purpos
Page 616 and 617:
614 MANAGED CARE PENETRATION The de
Page 618 and 619:
616 CHALLENGES AND RESPONSES Our re
Page 620 and 621:
618 > In building up and maintainin
Page 622 and 623:
620 * For the most part, the agenci
Page 624 and 625:
622 beginning to look for associate
Page 626 and 627:
624 challenge will be to ensure tha
Page 628 and 629:
626 RETOOLING AS AN ISSUE Retooling
Page 630 and 631:
628 finding effective ways of deali
Page 632 and 633:
630 COMMENTS ON THE DRAFT REPORT We
Page 634 and 635:
Defining Managed <
Page 636 and 637:
DATE: JU 27 1997 TO: June Gibbs Bro
Page 638 and 639:
636 protocols will be enhanced thro
Page 640 and 641:
638 Broad and explicit state health
Page 642 and 643:
640 APPENDIX C ENDNOTES 1. See, for
Page 644 and 645:
642 The First Biannual Report of th
Page 646 and 647:
644 30. In Massachusetts, for examp
Page 648 and 649:
646 CHILDREN WITH SPECIAL HEALTH CA
Page 650 and 651:
Prface 648 The U.S. Maternal and Ch
Page 652 and 653:
650 L DEFINING AND IDENTIFYING CHIL
Page 654 and 655:
2. Child Health Questionnaire (CHQ)
Page 656 and 657:
654 Limits * This approach identifi
Page 658 and 659:
656 To what extent does the definit
Page 660 and 661:
658 II. FAMILY PARTICIPATION IN MAN
Page 662 and 663:
660 Description This is an integrat
Page 664 and 665:
12. American Academy of Pediatries
Page 666 and 667:
664 knowledge of a child's conditio
Page 668 and 669:
666 though only the NACHRI approach
Page 670 and 671:
668 Sources Ash A, Porell F, Gruenb
Page 672 and 673:
C. Recommended Adivities 670 With t
Page 674 and 675:
672 B. Examples of Current Research
Page 676 and 677:
674 The Practice Parameters Project
Page 678 and 679:
076 -Administrative Survey: Enrollm
Page 680 and 681:
678 Description This guide provides
Page 682 and 683:
680 APPENDIX 1: PARTICIPANT LIST MA
Page 684 and 685:
682 MANAGED CARE EXPERT WORK GROUP
Page 686 and 687:
684 APPENDIX H: BIBLIOGRAPHY MANAGE
Page 688 and 689:
686 MANAGED CARE EXPERT WORK GROUP
Page 690 and 691:
688 MAKING MEDICAID MANAGED CARE PR
Page 692 and 693:
690 On Saturday, July 13, 1996 and
Page 694 and 695:
INTRODUCTION Medicaid</stro
Page 696 and 697:
694 INTRODUCTION People living with
Page 698 and 699:
696 |CONSENSUS FOR ATO of many of o
Page 700 and 701:
- 698 There is a huge need to educa
Page 702 and 703:
700 People fiving with HIV, and the
Page 704 and 705:
702 The HIV epidemic disproportiona
Page 706 and 707:
NATIONAL ASSOCIATION OF PEOPLE WITH
Page 708 and 709:
706 People living with HIV must be
Page 710 and 711:
708 CONSENSUS FOR ACTION service Fo
Page 712 and 713:
710 E . | CONSENSUS FORACTION Peopl
Page 714 and 715:
712 CONSENSUS FOR ACTION _ Under Cr
Page 716 and 717:
714 PNDX Aj MedIcaId -A health care
Page 718 and 719:
Resources 716 NAPWAserves as the vo
Page 720 and 721:
Medicaid Working G
Page 722 and 723:
Background 720 FAMILY"7OICES A nati
Page 724 and 725:
722 was included. A telephone numbe
Page 726 and 727:
724 provider to ask questions. fami
Page 728 and 729:
726 * Families were twice as likely
Page 730 and 731:
728 carefully to explain why they a
Page 732 and 733:
Table I Family Voices Survey on <st
Page 734 and 735:
Table 2 (continued) Family Voices S
Page 736 and 737:
Table 4 Family Voices Survey on <st
Page 738 and 739:
736 Table 7 Family Voices Survey on
Page 740 and 741:
738 Table 8 Family Voices Survey on
Page 742 and 743:
740 Table 10 Family Voices Survey o
Page 744 and 745:
al 742 Table II Family Voices Surve
Page 746 and 747:
744 Tn Uvman 1usoUU - Ya..e. PeMh i
Page 748 and 749:
746 Tihe b d. - Yc'.n-e-aPcopb bith
Page 750 and 751:
748 UT1, W L= 1. - Y g o. ith ,Pb M
Page 752 and 753:
750 o As with the rest of the <stro
Page 754 and 755:
752 Mlbe 1 Mediaid Benefici7 ibtas
Page 756 and 757:
754 9: Office of the Assistant Secr
Page 758 and 759:
The research for this paper Was sup
Page 760 and 761:
Definitions of "Medically Necessary
Page 762 and 763:
Who Should Define What Is Necessary
Page 764 and 765:
762 contract. In that situation, th
Page 766 and 767:
764 sannes and for certain conditio
Page 768 and 769:
Defining Elements of a Definition o
Page 770 and 771:
768 (6J identify and evaluate a men
Page 772 and 773:
770 This paper highlights children'
Page 774 and 775:
772 din resulut in inadequate or in
Page 776 and 777:
774 dividual under public-sector ma
Page 778 and 779:
BAZELON CENTER RESOURCES ON MANAGED
Page 780 and 781:
ivn58ffR1eL_ 778 THF VARIAI LITY OF
Page 782 and 783:
_4 What are the essential benefits
Page 784 and 785:
WHAT PUBLIC PURCHASERS CAN DO - Oen
Page 786 and 787:
ASSESSMENT OF STANDARDS - Quality M
Page 788 and 789:
Accessibility, Availability, Referr
Page 790 and 791:
- Credentialing and Recredtentialin
Page 792 and 793:
Standards for Members' Rights and R
Page 794 and 795:
Preventive Behavioral Health Servic
Page 796 and 797:
9b4 etfJovrk9imut July 16, 1997 794
Page 798 and 799:
hel,4Neipaork SEmi July 16, 1997 79
Page 800 and 801:
798 Principles for Accountable <str
Page 802 and 803:
800 The Coalition for Accountable <
Page 804 and 805:
802 Principles for Accountable <str
Page 806 and 807:
Im. Community 804 Health plans shou
Page 808 and 809:
806 4. participating in community p
Page 810 and 811:
808 5. give patients opportunities
Page 812 and 813:
810 aRve New Children With Disabili
Page 814 and 815:
Table of Contents 812 Executive Sum
Page 816 and 817:
814 combination of HealthPartners d
Page 818 and 819:
Introduction 816 F amilies whose ch
Page 820 and 821:
818 Of the 24 families asked, 13 pa
Page 822 and 823:
820 Shriner's Hospital, or claims s
Page 824 and 825:
822 Major Child and Family Concerns
Page 826 and 827:
Services and Funding Sources 824 Nu
Page 828 and 829:
Physician Survey 826 M ost physicia
Page 830 and 831:
828 Discussion and Recommendations
Page 832 and 833:
830 * Claims and billing informatio
Page 834 and 835:
832 El Advocate for a safety net of
Page 836 and 837:
834 :i:PTNG F'AITH SYMThMr -"r W, M
Page 838 and 839:
836 We recognize that managed care
Page 840 and 841:
due to a host of complex demographi
Page 842 and 843:
affect many different facets of an
Page 844 and 845:
state agencies, must be held accoun
Page 846 and 847:
In selecting managed care entities
Page 848 and 849:
Z, W 0 V==4 . k PQ- 0 V-- 9 Q) bo =
Page 850 and 851:
plans were virtually identical in b
Page 852 and 853:
to chronically i persons has been t
Page 854 and 855:
Managed Risk Medic
Page 856 and 857:
the lead. Large purchasers might wo
Page 858:
ISBN 0-16-055952-9 9 [ 10111111 155
show all

Medicaid Managed Care - U.S. Senate Special Committee on Aging

Create successful ePaper yourself

Delete template?

Save as template?