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

_4
What are the essential benefits
and cavegones of services that children
with special needs depend on? Are man
aged car pl-es organized to ponnide
those benefits? Or should some services
be 'cared out' and provided by specialaned
or fee for-service plans rope in
reas eat traditionally handled well by
managed care, soc as mental health,
tanspoation, home and respite cam,
special education and norsing home care7
ft states enroll special needs kids
in maeaged cae, shoold they negotiate
with a plan that offers an organroation
designed to pronide bn-ad access to
pedia-ec specialists, ther than maeistreaming
them into plans that serve a
broadrr popolatiorn
What is the best means
to reward plans that enroll special needs
children? Shoold capirared rtes be
adjusted upward to rehect ike higher
costs-aed if they should, do we hane
the knowledge to adjast them wisely?
Should states dnelop arte so- nce pool
to protect plans fom excessive losses?
ACKNOWLEDGMENTS
This prblarirwr -t made possible by a g-nt
fhm the Rober Wood .home FPndanon
We are panietdady grathi for the adine and
sappor of Jdy Wrhing ad May Kaplan
The Alliame uodd aho like to dthak pediaociran
RBth EK. Stein, MD., of the Albn
Eintrein Celtege of Medicine ahk -esraro
and policy aesysit fhemed moh of dte basis for
ihit paper Thanks alw s Judy Fedro of
Cpronoesa Univ-niVn's 1n-tirura for Health
<strong>Care</strong> RBsh and Poicy and Allisem intrer
Danid Maihn.n and Cars Aedolma
The Allisem isa hipaotoi no.r fpofit
arp committed s thie ed-ation of j-iilisn,
rlecded oAdoats and odorp shaper of public apim
ion in hleping dthm bom rodestand dhe -eo
ahlie rations halth Pmblems ted the madsifh
posed by o rehsmm prposals The AMiae
watuloddr 1991 whelp prvidorpinin
leaders an objeniernscetC o- infonmearon ac
thaw prbooms and prposdsarum
Drsign by Pent-ar Deign Group Ltd.
REPRINTS
An adhisora op f hroli papesrem fs ahianedfy
wakeg a 4-fsIdmd iy o 6me asipjb era pastga b
Alliance tar Health RBFton
910L SireeiW, Su- 512
Washirgin. DC 20036
F.r aahpk cpop
Telrpho- 207J46s-5626
Fan 202/7466 6525 0 1997 * CJ "
780
Current pediatric quality measures
focus on prnmary and preventiee n, soch
as immunratto.n rte and well-child nisits
Them am few mea-om for kids with
chronic condinons What mearore sho-ld
be used to ass-r thes children n c-er
apponpoate cam, and what public or pervote
agency should deelop the standard?
What other prtections - an appeals
proces or nght so pediasoc specialiso, foe
ecample - should he considered?
Can managed care realize
its potential to enhance the quality and
imp-ose the coordination of the comple,
care of children with special health
neds - and ocki-ne sanings for a11 the
poblic and perare health and education
progrms ineolved in pnoviding the
care?
CONCLUSION
Childron with special health needs could
benefit from the coordination and manageme-t
of cam offered in a managed core
environment But the co-pleoity of their
needs makes the sks high as well -
foe families and for the plans While managed
caee has findartentally changed the
health caee marktplace, policy maker,
employees and plans should all moon with
caution and senoticity when nyning these
children with special health neds as managed
cares newest clients
END NOTES
FOR-MORE INFORMATION,
i Based on data hem Phase I of dte Disbiliry
Swvny condoted by the Nationdl Center far
Health Staistics as pas of it 1994-95
Nanonal Heath Interview S.rcy
2. Frm the Natiol Association of Childrens
Hopital ted Relaed I 1titiars 996 Cas
Mi. Database
U Polly A.ango, Fomily Voices
U Cannel l Bocchion, Amerrcnn Assaciration of Heolth Plans
U Harriet Kohe, Center /ar Children mith Chronic 11tness
Disobiity, University of Minnesota
U Patrick Chaulk Annie Et Casey Foundotfon
U Bob Cole, Woshingtoo Business Gnup on Heolth
U Margot Edmunds, Institute of Medicine
U H-arette befox, Heolth Policy Consultonts
U Henry Ireys, Johns Hopkins UnWcersity
U ane Kopplman, National HeoIth Poicy Foyum
U Richard Kronick, University of ColiRhmoi School oP Medicine,
Son Diego
U Margaret A. MManus, McManut Health Policy tnc
U Mere McPheron, Mote-ol and ChiMd Heolth Suyreou
Deponment of Health ond Ham.n Services
U Paul Ne-acheck, Uiersiity of Caofomio at Son F-ncisco
U fackie Noyes, A feicon Academy of Peditrics
U lames Prlem. Mrsnchuetts Geneonl Hospital/
Haortrd Medicot School
U Sa.ra Roseebasm, Center Pat- Heolth Poficy Rfion th
George Wonlngton University Medical Center
U Stephne Somer, Center Par Health Core Stosteples
U Ruth E K Stein, Albert Elnatein CofIege of Medicine
U Sallie Strng, Notional Association of Children's Honpitols
& Rdotaed Institutionn
U Mary Tiemey, Health Services for Children tith <strong>Special</strong> Needs
U Myd Weinbeg, Notionol Health Council A
3 The Censor Borradehcdibtaility s'dfficoiry
in perfonming one or mom crional .. or
daily livino acrivices, or no or mom socially
defired soles or task. Person who am emplerely
unah.e so p-rfnon an auciry or ask,
or who most hace prsaal assist-nce am considered
to hk tanner- disability"
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