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

More documents

Recommendations

Info

672 B. Examples of Current Research and Innovative Approaches Quality indicators are needed for a number of purposes -- accreditation by outside organizations, external monitoring for the purpose of population-based planning and regulation, marketing to provide information to purchasers and consumers, and internal management of the plan. There are numerous efforts underway to measure these different aspects of quality. Some are focused on developing improved measures for structure, process, or outcome and others are aimed at developing conceptual frameworks. Several of these new initiatives are summarized below. I1. <strong>Medicaid</strong> Health Plan Employer Data and Infonnation Set (HEDIS) Purpose Relevant Quality Indicators Source Provide state <strong>Medicaid</strong> agencies with information on the performance of their managed care contractors, assist managed care plans in their quality improvement efforts, support emerging efforts to inform <strong>Medicaid</strong> beneficiaries about plan performance, and promote standardization of managed care plan reporting across the public and private sectors. * Utilization measures -- ambulatory care, newborn care, mental health, and chemical dependency * Access measures -- availability of mental health providers and low birthweight deliveries at facilities for high-risk deliveries and neonates * Quality measures -- substance abuse counseling for adolescents; low birthweight rate; ambulatory follow-up after admission for specified mental disorders; and asthma inpatient admission rate * General plan managements measures -- quality and service improvement studies, case management; utilization management; arrangements with public health, education, and social service entities: new member orientation and education; and pediatric mental health services National <strong>Committee</strong> for Quality Assurance: HEDIS 3.0 Draft: Health Plan Employer Data and Infonnation Set. Washington, DC: NCQA, 1996. (Request from NCQA, 2000 L Street, NW, Suite 500. Washington, DC 20036; Phone 202-955-3500.) 23 I
673 2. - .Agency forHealth <strong>Care</strong> Policy and Research's COmputerized Needsoriented I QUality measurement Evaluation SysTem (CONQUEST 1.0) Purpose Relevant Quality . Indicators Source Provide a classification scheme and database that identifies and summarizes available information on clinical performance measures. The measure database includes 1,185 measures and the condition database contains 52 conditions. The condition database includes the following pediatric chronic care measures: ADHD; anorexia nervosa; anxiety; asthma; bulimia nervosa; early HIV infection; diabetes - Type 1, 11; otitis media-acute, with effusion; pediatric HlV positive: schizophrenia: and sickle cell disease. Center for Quality of <strong>Care</strong> Research and Evaluation: Conquest 1.0: A COmputerized Needs-oriented QUality measurement Evaluation SysTem. Boston, MA: Harvard School of Public Health, 1996. (Request from Center for Quality of <strong>Care</strong> Research and Education, Harvard School of Public Health, Boston, MA 02115; Phone 617432-3270.) 3. American Academy of Pediatrics' Qualiy Initiatives Purpose Relevant Quality Projects Conduct, coordinate, and disseminate research on improved pediatric care. * The Functional Outcomes Project is developing conditionspecific measures for asthma, otitis media, juvenile rheumatoid arthritis, and head injury. The functional areas that are assessed include physical activity, emotional health, socialinteractions, and health care utilization. These are currently in a pilot-test phase. The long-range goal of this project is to develop measures for several of the most common or serious conditions affecting children. 24 - I
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:
Page 116 and 117:
Page 118 and 119:
Page 120 and 121:
Page 122 and 123:
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 136 and 137:
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 146 and 147:
Page 148 and 149:
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 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 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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?