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

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and chest pain sufficient to require hospitalization (MOS unpublished data). These preliminary MOS results are consistent with published studies that have linked SF-36 health scores to disease severity and to treatment response, including severity of soft-tissue injuriesand changes in hematocrit amongchronic dialysis patients The SF-36 studies of outcomes have also linked treatment to outcomes including drug treatment for depression among the elderly~n total knee replacement,n7 heart valve replacement surgery~i use of aerosol inhalers in treating asthmas, intermittent vs maintenance drug therapy for duodenal ulcer," elective hip arthroplastyi elective coronary revascularizationa and various other elective surgical procedures.' Three dozen such studies using the SF-S6 are cited elsewhere.n Identification of the clinical correlates of changes in physical and mental health status warrants high priority in outcomes and effectiveness research." Future studies should address whether variations in the quality of care explain differences in outcomes across systems. The MOS patients in HMOs reported fewer financial barriers and better coordination of services in comparisons with equivalent FFS patients.'z Analyses of primary care quslity criteria indicated that those in FFS systems experienced shorter treatment queues and better comprehensiveness and continuityofeare and rated the quality of their care more favorablyms Do such variations in process account for differences in outcomes? Practice-level analyses in progress have linked scores for primary care process indicators' to 4-year health outcomes, as defined here, supporting this hypothesis. These and other asosociatios warrant further study to determine which practice styles and specific treatments are most likely to improve health outcomes. Because many of the structural and process indicators being relied on to evaluate the quality of current health care have not been shown to predict outcomes, targeted monitoring efforts are required to discern health outcomes. The MOS has demonstrated the feasibility and usefulness of readily available patient-based assessment tools, such as the SF-I6 Health Survey, in monitoring outcomes across diverse patient populations and practice settings. The SF-36 summary measures of physicai and mental health reduce the number of comparisons necessary to monitor outcomes while retaining the option of analyzing the S-scale SF-36 health profile on which they are based. The reporting of results in change catego- 1041; JANA, OCICWb 2,19S96-Vo 276, NO. 13 164 ries in terms of better, same, and worse may simplify the reporting of outeomes to diverse audiences and may make results easier for them to understand. More practical data collection and processing systems-under development-and advances in understanding of the specific treatments that improve health scores the most and the clinical and social relevance of those improvements will increase their usefulness in improving patient outcomes." Policy Impllcations The MOS results reported hem and previously' for the average chronically ill patient constitute good news for those who consider HMOs as a solution to rioing health care costs. Outcomes were equivalent for the average patient because those who were younger, relatively healthy, and relatively well-off financially did at least as well in HMO0 as in the FFS plans. However, our results sound a cautionary note to policymakers who expect overall experience to date with HMOs to generalize to specific subgroups, such as Medicare beneficiaries or the poor. Patients who were elderly and poor were more than twice as likely to decline in health in an HMO than in an FFS plan (68% declined in physical health in an HMO vs 27% for FFS; P
165 1 Tnrio AR, Ware IE, Creiseld S Nelson EC, i msoltu from -the Pe-ein Media d E. ZikariL em Sody. e~ Mdialrst MUd eStody Cm. 1995=esp 4XAR264ASMT t ypb.atio f ethod r m tir be IS MeHssnyCAWareERKuc AE.T7IeMOS sldt of medil are. SJAVAL li9 930. 36-Item Sh F-Pore Hadth Surey 4 (SF436). GCfieUd II: S Roien W. MYogxLh M, <strong>Care</strong>y p ymomesew sod slioial test of vstidoty M'F. Tee-n is e- ARI O m f ptiesti with hypes. momg physim nd emote] haItb teasl Med tis d m-o .deperset dise mli- Cor. lt9i2it247 itil. to Uteied by duff-eet eet eod spedlWties IS. Diehr P. Pateh D. Hedeik S Be L Intdg -tls emthe Medial Ome Sady. JAMA. desthm wio oenog heath oer tim- 199Si74:143b-1474. Med Core I994 4Oppl 4hAS164-A17I S. Wells KB, Hiye RD, Bioe MA, Rogen W, 17. STATA Rf ao Roles.1, GCeted Vol. Si We SE. Detetie of deesiv duorder for tm petietot J. 6th bd. .eioog College preped Satios, or fr-for- Ten STATA Cop: 1993.3-16. anise o eo hom the Medial Osiiose tI. Wo JE. Bok RH, RogeW Stidy. JAUA. esid Coi- l i916:39,~ puioonssooflhedLthmot .o deadl h mhistresri L Roger WIH. Wells KM Meredith LS. Sooro R, eg aioso with those offesorsrr ea. Ls B oR A. toosor foe edolt ootpsiseo mith e L %t 9t.:1ll17.tlreM deprsion ueder preqid os fee-or1-erie Ioo-- 19. MooimgWC Loibmi. A, Goldbe log. GA, Al Rog- G PG oitolp. B993250il7-5M. es WH Newhmar SP. A .. tstled 7. tWis SBtee of the AL. Wore JE. edt. M-ae .p Poor effett of a prmpsdd gtiip ptetis toossg sue ofieensod Wel&i.ge Tirs Modi-o oot N Engl J .Me 199513101506-lBSI. Seiiy Appok Dorhoo. NC: Dfko Uieeity 20. Cock TD. Cempbho DT. Tie dsige sod me- rS~ 19w- duonmt sloorrpseoimnss sd Lessespemtesosis & Knei. RL,G d S. R WN, eta . Di- feld onetisg. In Dsoicto MD, od. H mrdhok of feree is the m. of paoi.o neing osodal epe lodinol ood Or toortiieil PsyohoIMy. Chi. stdaesti] sy of : lmo frmo the Me.lir ago Ilk Rod McNay ColegsPfbiihingCo 1976: om Sdsty. JAMA 199fl67.tt7-16L3. 9. Slew AL, CeenGfeid S. Hays RDeltel. Po.- 21. Lime N, lioleooni soodiell~heisgofpooreotsotholirooie -oditiots- mols hem the Medial Owoono Strdy. JSAA 19W255907.913 10. Beny S. Methode ofolletiog helith ds. ln SU!W AL. Woes JE, d MUriny F.odioo. irg ond WeU-teep The Mdirs folesw Sordy Appwoe Diirhim, NC: Dkei Uiovenity Prs; 1992:48.1. IL CGegshidS.N.oECoZKbkoffMeeteLVsrio. toes m moons utiioatios tmog medial spil. lies aid tywst- of -re: reeco fhem the Medial Goto Stody. JAVA 199524.t716b30. tI. Safra D. Tarov AR. Roger W. Primity a perfsnma- m fe-for--re k odpespaid helth cra systes: ..stou hem the Modold 0Otoomes Stody. JAMAr 1994y271:1579-1586. 11 WonJE, KBln M KimhM eller SSF-o6 PFh ot mid MUo Hoith Sommcry Scolrs A Use-k MonuL Boton, M The HMthilotitct., Noe Englod Medial Center 1994. 14. Wo JE, Kmis M. BaylfiS, MeSorey CA, Roger WN, RB k A. Comporis of methol for M orimg ord stailal ooyou of SF-46 Helith Pr.bM. sod Slmiary M -eu : -commry M n. R-t ME, Harem WJ. LeiUky K, Wo JES Darie ARL Methods hr .. m.g eeti-p dbe are gee. ic Bownia sts m ato total ko repluteemn. MVd Coe. 1992lippi 5)YMS4B0-MS2M 2. Hawhes C, Mel1 C. PNd J. GCes R, Bsmbr-. dies C. Cotpooss oft ge-eso (SFP-6) od o deo -epedif (WOAC)ieseIe mtLemesmeet otomes aft er oes rpo t ogery. J RhesouL 199IBZ:lf3-)196. 29. Phillip RC. Loosky DJ. ODuomer sge meet i heart salve rploonwst megeery ealy espeeeem. J Hacr V.ote Dir. 192)l.42 dO. :. Okarac L, Neo M. KirM-oforL, Beoye JG, Relles DiJ Use JA. Qooity of lh is petial mith svens sts bhUee health pr- Re sod effesu of noia pwpioae .ee .oL Ann AUlrepp A.th0m Immuod. 1996,76;17. 31. Rmps P MrisC. MeqoisP. W JE Boe. _. S. A qoUly of life tsdy is Bre h.ored rod eighty-see deodent otrer psoirt. Saed J Go.. tn le. 199429(ssppllA4-51. 32 Sehi GC Limg Ni, Phiiim C. i:,:oSN 2Te Sheet FPonni6 upn efbhl tc thelSIPMao geono. health Utot meoson is perot sodesgoirg alestine total hiprhwophety. Athirf. Cor -ee 19953 &.174-181. sonover IS, Fmeh , Chitiaseos 332 Keshol MM Mo rinsy CA, Chk L, JB. PopkiY ML De apitaon dffe the healthof Lev--eii M. Bui DS, GCbld L. Chigre is the ohrimlymensoly it? moltmm oaealste haWth after delee psretasoena- cowm-ry e- ihd teal. SAVA. t9922do2&7MAOli. oloebo in a ssmpaeiooo of genesis ood epe,&So 29. RItohis SM, Cl-mos DC Roo-itr LF. B -s moasoree, Med Cr.e 199634:754-759. B. BDres R, Neios L. Hot the oldomly bre is S4. TemplePC. TviB, Swh L.S rS.Chg- HMO.: ostoome- hem ohs Medire rerpotihs boo P. FPboai L. Fsoisigo d -weB-euigof demoestestisn Health Sen R.e. 199Z27651.669. patiee hoeso sd tIter sls-i-e scoia p- 23. Clomosi DC, Reihs SM, Bw RS, Steogf dons J Am Coll Scy. 15:;181:17-25. MH. An d etermen of Oldedy paient en- 3U ShelyJ-C, Boyles MS, Kstee SD, Tesi C. Won .ledis misgd -eaJsSAA 19941271:1457-1492 JE. SF46 Hesith Son.y A4nolsted RiBiogwphi: 24. Bossps DE. Bomhbrdir C. Hoggohmoe S. Fret EdiWon, 198O.i995. Bto, his: ThrModith Chisre year tool:. oopo-i onsfrltho poyshometo Ibatitoe. Now Enghmod Medial Corill. Is pres pmp-enie of IIs genec heldhstah s iatiwsenis 36. BoporWL WiokhossndorW HIakbhrthCGM. mtorke- sith eft tiol.s ijoitm. Qol: Lfi R-s Knosroo H. Efertioes is hsolth an - in- 194.:3Si-56. tiotivo to evotoato sod oipis- medal psrtios. 25. B toeen KM. Nimoo AR. Pot FK, ReW ,V Eg Jl.frit 1968st19 1197 1202 MY Stoissld B. W.eJE.Therlsffs of rmbi- 27. RSbisM. Co. dbk B. Rogen Wi!, KEirll M, .a-t hoism nr-thwpioho so irisonl health omd MWHrowy C. Won JE. Patients miogs of sopte weUkbemg is ohnox diolys- pasiest. J Ar Sor ticot visiu in differet p-etion sottigs: mnsts ,Vephio 1996;7:111. hem the Medial Otemie Strdy. JASIA. 1993- 26. Busiemes K Steiiwald B, Won JE. Urel- 207S184 eso ofrho SF456 he-lths-rvsy in mser-ng helIth 3S. Davies AR. HMlpen R. HB lth Core Ocrisir oitmes is tho depred elderly. J GCor PFy An Istinderiso. Ining, Ton: Vobosio-y Hospiub chit, eN 19%9g93- S9. of Ami-ie en1 199i. JAMA. October 2. 1556-4d 276. NO. 13 CI-iotcally Il BEltioily end Pose Pating-taWo eetal 1047 ad
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S. HRG. 105-262 MEDICAID MANAGED CA
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CONTENTS PEOPLE WITH SPECIAL NEEDS,
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V Bazelon Center for Mental Health
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2 also apparent that structuring a
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4 through the doors when somebody o
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6 delay the onset of secondary disa
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8 BRIEFING FOR CONGRESSIONAL STAFF
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10 obstetric and gynecological serv
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JlSAes CRi. E CalD5Vilb J~iiiLi uls
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14 people with disabilities and spe
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16 and prospective enrollees the pl
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18 by the disorder. In fact, schizo
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20 r_ 06/23/1997 16: 03 7836845968
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22 Kathy. STATEMENT OF KATHLEEN H.
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24 even lead to an improvement-but
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26 MANAGED CARE AND LONG TERM T h e
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Consortium for C. 20249&Oid Citizen
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30 11 Managed care
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Strong Oualitv Assurance Measures 3
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NATIONAL ASSOCIATION 34 DEVELOPMENT
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36 Mrs. M.'s care plan is quite com
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38 nurses and social workers be ava
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40 EXPENDITURES FOR NURSING HOMES S
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REQUIRES THE SKILL OF A HIGHLY TRAI
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44 ALZHEIMER'S DISEASE AND RELATED
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46 WITHOUT ADEQUATE RESPITE CARE, I
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48 PROBLEM FOR PEOPLE SUFFERING FRO
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50 Ms. CHRISTENSEN. Thank you. Don.
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52 it will eradicate the virus. Man
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I 54 Today I participate in a state
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56 Ms. CHRISTENSEN. Thank you. [Ina
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58 rather than to community-based s
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60 now has to start looking at thin
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62 plan for that matter, can measur
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64 ual is getting state-of-the-art
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66 a larger population of people wi
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68 of recovery or rehabilitation th
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70 are entitled to renew their pres
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72 point and say that Patsy comes f
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74 .The WASHNTND MEDICAL CENTER CEN
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76 exceptions - have largely based
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78 Plans have not shown a willingne
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eligible people and for the program
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Table l.b Selected Provisions Relat
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VariiaIioils in rownlr-c1t language
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Variations in cbonIlrlcl Is1sgu;age
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Executive Summary 1. Setting the Co
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age, which pays for those M
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This consensus building exercise is
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95 Ms. CHRISTENSEN. I'm going to in
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97 abled population will all need s
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5601 Smetua- Drive PO. r,. 9310 Mmn
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101 Our experience with the AFDC po
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103 I have tried to list both the o
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105 BACKGROUND INFORMATION PATRICIA
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164 Communicating the Quality Messa
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Page 118 and 119: 170 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 164 and 165: AP Ag. 0065(0 og. qP e8 y. d-ftd 04
Page 166 and 167: 162 Tlbb. 5-Plso91 A& MerohJ H89t0
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
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2 SELECTED INDICATORS Access to <st
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Mental Health 217 * HMOs reported f
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'Nisconsin Medicaid</strong
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Program for Program Chareolorletice
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Primary Program AFDC/H8 Provlqar Ch
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225 Children Come First of Dane Cou
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227 Wraparound Milwaukee saving dol
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229 Another positive outcome of the
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231 AltDoughl Nkvie' iniCil costs i
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233 CCE's staff consist of a variet
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235 Al the cturent time, there is n
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237 PACE/Partnership programs guide
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239 necessarily relevant to the AFD
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241 about including these specialty
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EXECUTIVE COMMITTEE Ct-u B.1r- M.mb
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Considerations: 245 Enrolling <stro
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247 Medicaid <stro
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a. some counties 249 b. mandatory e
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251 counties as well-of managed car
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253 In other States devolution is m
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255 /-LCenter for Health Ca
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257 Forums on Managed</stro
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259 Medicaid Carve
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261 So I view Medicaid</str
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264 Medicaid: Spen
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266 a 50 percent match. 2 Since 198
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268 If enrollment of eligible indiv
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270 drugs, ICF services, and optome
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272 Table 20-1. Medicaid</s
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274 The slowdown in spending after
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276 Section 1115 Demonstration Waiv
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278 primary care case management ar
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280 Table 20-2. Enrollment in <stro
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282 / Figure 20-6. Enrollment Growt
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284 Marnaged-care growth at the sta
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286 Figure 20-9. Enrollment in Risk
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288 The extent of problems in repor
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290 plans (PPRC 1996). In other are
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292 There appears to be a clear tre
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Enrollment and Disenrollment Polici
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296 individually with plans over ra
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298 Health Care Fi
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Medicaid M
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Support & Services Office 120 W. Tw
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INTRODUCTION 304 Presently, nearly
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306 more mandatory services. Full-r
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308 the ability of beneficiaries to
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310 managed care also requires the
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312 condition period. Such requirem
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314 If a state contracts with or in
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Appendix A State Activity* 316 Many
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GA { I ~United States (3 Mu General
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Results in Brief E.. - 320
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Significant Efforts Needed to Ensur
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Recommendations Agency Comments E-d
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cow 326 Chapter 4 Traditional Rate-
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Chapter I Background 328 Me
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ovapt I 330 the option of extending
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Federal Requirements Govern State U
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Table 1.2: Comparison of Ma
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Objectives, Scope, and Methodology
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338 Chapter 2 States Are Moving Tow
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Table 21 nEnollmen of Disabled Bene
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342 chona Se. As To~ed Id C"fn, Dai
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Table a& Eabent to Which 17 State I
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346 So A- hbydf TSo -d Cam fo DIbbi
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Table 2.5: Extent to Which 17 State
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350 8t" Age Bowi T-Mar 11 Cue fRa D
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352 C".Pt a Q...itA- Efl~t. . - C f
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Addressing Concerns Through Enrollm
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Assignment Active Management of a D
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358 fo.V D Axd B ref .Ak,.d - CC-e
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Targeted Quality-of-Care</s
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Encounter Data Analysis Shows Poten
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364 Chapter 4 Risk-Adjusted Rates a
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366 Cu.pd 4 Rk-A4tAjLd Row Ad RIASW
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States Could Experience Adverse Sel
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370 Ckspt. 4 JUek-Mtod Rate Wd HIa
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372 Ch.piWr 4 JU-i.k.d Row md RJAk-
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374 Coob,, 4 RkikAdjned Rtr -d Rub-
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376 rued R.I. . 2".shBd c- provider
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378 c-5 Obh- .. I, Co.eWda, ad CHe
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380 Ob-e-eU-o, Co-ded, end C-ost pr
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382 United States General Accountin
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Results in Brief B-Z70335 384 manag
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B-2Kn0 386 assess service utilizati
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Table 1: Characteristics of <strong
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B-27035 390 numbers of patients. In
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B-270335 392 number of primary care
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B-Z7Oa33 394 developed on the premi
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States Challenged to Develop Effect
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B-270335 398 that beneficiary use o
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B.270335 400 of the care provided a
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States Could Learn More From Improv
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Targeted Analyses of Grievance Data
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Observations Agency Comments and Ou
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B-270335 408 Finally, the experts w
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410 Appendix I Scope and Methodolog
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- I 412 App-edU I Sw Wd Methodology
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414 AppeAdt U Fedo.I aod Stt. Ove0s
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416 Appendix III Major Contributors
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GAO July 1996 GAO/HEHS-96-120 418 U
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B-26632 420 family home, rather tha
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Background 1-206320 422 traditional
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States Use Waivers to Expand and Ch
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84=20 426 Figure 1: Staftes Use of
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B-266320 428 began the 1990s with s
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B26320 430 variety of other service
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Enrollment Caps and Management Prac
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Change in Federal Rule Could Result
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States Are Introducing Innovations
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B-nato 438 offered and the means fo
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440 We are sending copies of this r
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C-m 442 Table 2: Changes in Number
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444 App-ar I So-p and Mraodsogo ent
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446 Appendix H Medicaid</st
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448 App-di. f M~I Wd., _. So 4 Of0
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450 App-.i. il _-.1 - Desd s UCFVA'
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452 Apeadls mn Stadad Seee - Defind
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454 Appedi. M St.d.ed Se&ee s Dneoe
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Chore 456 Am..& IV LAO n.Gd .Mt. ,
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Occupational Therapy and Assessment
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Psychological Services Provider Typ
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462 AWppdi IV U-e, Cotfi-, E d Othe
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Licensure/Registration Other Standa
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466 United States General Accountin
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Results in Brief B-276078 468 care
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B-270078 470 Medi-Cal was implement
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_.27_7 Tab 1: Mad-C Eiglbli and Enr
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~~- - o~~BZ760?S 474 I J I the enro
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B.276078 476 delaying the contracti
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State's Education Process Has Not R
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B.276078 480 and thereby supplement
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Weaknesses in State Management of t
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B-276078 484 standards can provide
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Insufficient Communication and Invo
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Some Safety-Net Providers Are Encou
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Conclusions B-276D78 490 Safety-net
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B-270078 492 current enrollment bro
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Contents Letter 494 Appendix 30 Sco
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(1115) oPP. -.M.taoy 496 oversight
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498 ACKNOWLEDGEMENTS This Volume of
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500 Is Lock-in to a Managed
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502 Plan and Provider Issues ......
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504 Chapter 1 Program Design Issues
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506 Other studies attest to improve
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508 Will the Program Be Voluntary o
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510 additional option for people wi
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512 contractor collect spenddown pa
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514 Option A is still quite rare. P
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516 experience with special populat
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518 particularly on a full risk bas
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520 Dual eligibility raises a disti
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522 special populations, and states
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524 Chapter 2 Care
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526 settings. Finally, plans that s
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5281 needs. For example, women who
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530 Oregon's rules require that pla
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532 beneficiaries on July 1, 1997.
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534 facility's delivery, dosage, an
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536 * Strategies for measuring netw
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538. arrangements with traditional
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540 community based or well elders.
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542 Finally, coordination for vulne
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544 Care Coordinat
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546 home health agency developed a
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548 develop a case management syste
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550 Coordinating services is compli
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Highlights 552 Effective care coord
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554 beneficiaries that belong to th
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556 services when needed. This is t
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558 federal government and not at s
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560 cannot enroll a person in a Med
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562 Medicare members are not typica
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564 Regence HMO Oregon staff noted
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566 community based organizations t
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568 Although technical advice for c
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570 Risk pools are usually used to
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572 Internal Quality Program Standa
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574 enrollee utilization patterns,
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576 that the overall prevalence of
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578 HMOs with risk contracts must h
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580 Summary As Medicaid</st
Page 584 and 585:
582 Chapter 3 Medicaid</str
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584 carve-out approach: - improves
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586 Coordinating Medical and Non-Me
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588 Oregon,8 program planners origi
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590 Medicaid syste
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592 Oversight/Monitoring Quality De
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594 with family and friends, contac
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596 * The type(s) of data necessary
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598 * Specificity of desired result
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600 Initiatives under way may prove
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602 a estring the services authoriz
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604 Development of appropriate plan
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606 OFFICE OF INSPECTOR GENERAL The
Page 610 and 611:
Establishing core developmental tea
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610 taken into account considerable
Page 614 and 615:
PURPOSE 612 INTRODUCTION Our purpos
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614 MANAGED CARE PENETRATION The de
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616 CHALLENGES AND RESPONSES Our re
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618 > In building up and maintainin
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620 * For the most part, the agenci
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622 beginning to look for associate
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624 challenge will be to ensure tha
Page 628 and 629:
626 RETOOLING AS AN ISSUE Retooling
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628 finding effective ways of deali
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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
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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
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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
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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
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Medicaid Managed Care - U.S. Senate Special Committee on Aging

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