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

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assess compliance with minimum standards. The final report of this
evaluation is being prepared.
* A review of plan quality improvement systems will be completed this year.
This review will examine all aspects of the quality improvement system,
including those specifically focussed on members of special populations that
were described earlier in this section.
* A review of plan systems for compliance with State requirements regarding
complaints, client rights and due process was also recently completed. This
review examined a number of factors that include access to interpreters,
availability of appropriate information in multiple languages, access under
American with Disabilities Act (ADA) rules, ability to meet the needs of
visually impaired members, written procedures for accepting, processing and
resolving complaints, a system for documenting complaints, option for
consumers to use the plan's internal process or to appeal directly to <strong>Medicaid</strong>,
and a procedure for reviewing and analyzing complaints.
Arizona
Arizona has implemented a clinical quality indicator project for elderly and
physically disabled beneficiaries. The indicators include immunizations, pressure
ulcers, use of psychotherapeutics, hospitalization and emergency room utilization,
activities of daily living (ADL) and fracture-related falls. Depending in the indicator,
data is collected through on-site chart reviews, encounter data and assessment
forms. The ADL indicator measures whether ADL scores have improved, remained
the same or declined since the previous assessment. Hospital and emergency room
(ER) use data will be collected for:
* the number of ER visits;
* percentage of members with ER visits;
* ratio of ER visits to number of members with visits;
* percentage resulting in hospitalization;
* . number of hospital admissions;
* percentage of members admitted during a year;
* ratio of hospitalizations to the number of members who have had
admissions;
* average length of stay; and
* the five most frequent diagnosis.
The data collected for each indicator will be used to develop baseline measures from
which later performance standards will be developed.
A focus study of members in nursing homes and community settings with pressure
sores was completed and a report was issued in February 1997. The report found
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