COD E R E D

More documents

Recommendations

Info

6. Funds obtained through the recovery of bad debt and charity care. 370 This idea is basedon the premise that bad debt and charity care is shifted to higher provider rates andpremiums. By providing affordable access to health insurance, Maine is anticipating thatsavings in the health care system will be obtained though reducing the amount of charitycare. If health system savings can be documented, the state will recoup some of thecosts of bad debt and charity care through levying up to 4 percent of insurers’ revenue tohelp fund the Dirigo Health Plan (though this is not mandatory). 3717. Maine is also relying on the successful implementation of several other cost containmentstrategies to keep the program affordable. These efforts include:a) Certificate of Need (CON) changes: 372• Expanded to include ambulatory surgery centers and doctors’ offices.• Requirement for review predicated on function and cost as opposed to site ofcare.• Capital Investment Fund to establish a statewide budget for capitalexpenditures and “to ensure a wise and appropriate allocation of resources”(expenditures must not exceed the limitations of the fund).• Reviews investments in new technologies costing more than $1.2 million andcapital expenditures over $2.4 million.b) Insurance Overview: expands individual coverage rate review to small groupproducts. Carriers will also be required to report administrative costs andunderwriting gain. 373c) Voluntary Limits on Growth of Insurance Premiums and Health Care Costs:Hospitals and other providers are asked to voluntarily limit their cost growth to 3percent and their operating margins to 3.5 percent. Insurers are also being asked tolimit their operating margin to 3.5 percent. 374d) Hospital Planning: The Commission to Study Maine’s Hospitals will conductanalysis of Maine’s hospitals, including an analysis of hospital finances, structures,roles, reimbursement, capital, technology, staffing needs, other pertinent areas ofstudy. 375Dirigo Health BenefitsThe benefits offered by Dirigo Health are:• Traditional services including inpatient and outpatient hospital care, 376 physician andspecialist visits, emergency services and prescription drugs.• Disease management, and health promotion and wellness initiatives.• Preventive services such as routine physicals, blood tests, Pap test, flu shots,mammograms and well-baby care.• Routine diagnostic tests, X-rays and surgery.• Occupational, speech and physical therapy.• Chiropractic services.• Skilled nursing care facility.• Ambulance services.• Cardiac rehabilitation.• Durable Medical Equipment.C-28
• Prosthesis.• Smoking cessation programs and medications.• Hospice and home health services. 377Private Insurance RegulationThere is no separate high risk pool. After Dirigo Choice has been in operation for three years,the Dirigo Health Agency must compare the impact of Dirigo on premium and uninsured rates inMaine with states that have established High Risk Pools. If trends in the other states are morefavorable than Maine, the Dirigo Health Board of Directors will submit legislation to create a highrisk pool in Maine. 378,379Maine has a modified community rating system. Insurance companies are permitted to varypremiums for coverage based on certain characteristics (e.g., age, location, and type ofemployment), but they cannot vary premiums based on the health status or claims history of apolicy. 380 There is a state rate review of individual and small group plans. Limited premiumincreases are allowed among Maine’s small group market. At least 78 cents of every premiumdollar increase must be spent on medical claims. 381 Insurers are required to reportadministrative costs and underwriting gain. Insurers are asked to voluntarily limit operatingmargins to 3.5 percent. Insurance companies will pay up to 4 percent of annual grossrevenues.Incentives for Small GroupsSmall group employers will be able to offer insurance at a reasonable price.Quality of Care InitiativesThe Maine Quality Forum will provide the public with information on costs and quality of healthcare. It will disseminate research and adopt quality and performance measures, includingcomparisons of provider performance. It will be funded in part by the savings offset payment(SOP) assessed on insurers.More Effective Use of Data is an effort to consolidate and streamline disparate data sources intoone cohesive database. It will include clinical and administrative data. 382C-29
Page 3 and 4:
Appendix ATask Force Members and St
Page 5 and 6:
Hector Balcazar, Ph.D.Regional Dean
Page 7 and 8:
Charles Haley, M.D., M.S.Medical Di
Page 9:
Michael McKinney, M.D.Senior Execut
Page 12 and 13:
M. Roy Wilson, M.D.PresidentTexas T
Page 14 and 15:
Appendix BMedicaid and the State Ch
Page 16 and 17:
services. There are two broad types
Page 18 and 19:
Mandatory and Optional Covered Popu
Page 20 and 21:
• Nurse-midwife services;• Fede
Page 22 and 23:
Disproportionate Share Hospital Pro
Page 24 and 25:
March 13, 2001, that limited the am
Page 26 and 27:
year from FFY 2002-2004, $4.05 bill
Page 28 and 29:
Medicaid beneficiaries. Section 191
Page 30 and 31:
started in 2001 and 2002 to curb in
Page 32 and 33:
urban and with fewer than 250,000 p
Page 34 and 35:
Protection Act of 2000 and the Medi
Page 36 and 37:
orientation). Recipients of Supplem
Page 38 and 39:
enrollee is assigned a primary care
Page 40 and 41:
Table 7. Texas Medicaid Policy Chan
Page 42 and 43:
Table 8. Texas SCHIP Policy Changes
Page 44 and 45:
families (through the employer’s
Page 46 and 47:
share of the match must come from t
Page 48 and 49:
Reinstating the Medically Needy Spe
Page 50 and 51:
Endnotes1 Texas Health and Human Se
Page 52 and 53:
35 Powers, Pyles, Sutter, and Vervi
Page 54 and 55:
73 Office of Management and Budget,
Page 56 and 57:
113 TexCare, Children’s Health In
Page 58 and 59: 150 Lyndon B. Johnson School of Pub
Page 60 and 61: States by Groupings with Current El
Page 62 and 63: Medicaid and the State Children’s
Page 64 and 65: Graduate Medical Education ProgramA
Page 66 and 67: needs, however, there is a shortage
Page 68 and 69: 15 Texas Association of Counties,
Page 70 and 71: ecording and evaluation; physical e
Page 72 and 73: Medicaid and the State Children’s
Page 74 and 75: ReferencesAmerican Academy of Pedia
Page 76 and 77: downloads/bipa.pdf#search='Medicare
Page 78 and 79: Texas Health and Human Services Com
Page 80 and 81: Appendix CAn Analysis of Reform Opt
Page 82 and 83: Encouraged by these low rates, Cong
Page 84 and 85: Establishing state-only tax incenti
Page 86 and 87: New York passed the Health Care Ref
Page 88 and 89: Hospital Cost Containment — Maryl
Page 90 and 91: dollar spent. 237 Texas spent almos
Page 92 and 93: Another option for small businesses
Page 94 and 95: • Medical equipment and supplies,
Page 96 and 97: pay the premiums for Medicaid benef
Page 98 and 99: Medicaid to children born after Sep
Page 100 and 101: Bill of Rights or “TABOR”; and
Page 102 and 103: The federal share for CHP+ is 65 pe
Page 104 and 105: SCHIP: increased eligibility in CHP
Page 106 and 107: • Medical equipment and supplies
Page 110 and 111: Status ReportMaineCare Program Expa
Page 112 and 113: the federal poverty level. 404 Sinc
Page 114 and 115: need their jobs as a source of empl
Page 116 and 117: Endnotes191 Deborah Chollet, Issue
Page 118 and 119: 225 Ibid.226 Maryland Health Care C
Page 120 and 121: 259 Kaiser Family Foundation, State
Page 122 and 123: SCHIP&subcategory=Medicaid+Spending
Page 124 and 125: 325 Kaiser Family Foundation, State
Page 126 and 127: 361 State Coverage Initiatives, Sta
Page 128 and 129: SCHIP&subcategory=SCHIP&topic=Feder
Page 130 and 131: An Analysis of Reform Options Devel
Page 132 and 133: ReferencesAdvantage Insurance and F
Page 134 and 135: Donnell-Kay Foundation. “Amendmen
Page 136 and 137: Kaiser Family Foundation. Demograph
Page 138 and 139: State Coverage Initiatives. Profile
Page 140 and 141: Appendix DLocal Initiatives to Expa
Page 142 and 143: with more coordinated services that
Page 144 and 145: FinancingSources of revenue include
Page 146 and 147: AdministrationThe Health and Hospit
Page 148 and 149: Until 1993, Denver Health (DH) was
Page 150 and 151: different benefit plans are offered
Page 152 and 153: Cost SharingPatient cost-sharing is
Page 154 and 155: management programs. I-Care promote
Page 156 and 157: the county indigent care plan. Bene
Page 158 and 159:
Firstplan xxvi,12Moore County, Mich
Page 160 and 161:
Benefits and ServicesEnrollees can
Page 162 and 163:
EligibilityAs of 2005, enrollment i
Page 164 and 165:
etween $23 and $120 per month. Ther
Page 166 and 167:
Healthcare Accountability Act xxxvi
Page 168 and 169:
Coordination - When health care age
Page 170 and 171:
subsidized initiatives offer exposu
Page 172 and 173:
arriers, two health plans attempted
Page 174 and 175:
xxi Simmons, Sandy Coe, Gionfriddo,
Page 176 and 177:
Table 1 (Continued). Local Care Ini
Page 178 and 179:
Table 2 (Continued). Local Coverage
Page 180 and 181:
Appendix EEducation and Health:A Re
Page 182 and 183:
The human capital approach suggests
Page 184 and 185:
etween standardized test scores (St
Page 186 and 187:
INTRODUCTIONEducation plays a wide
Page 188 and 189:
of children with chronic health con
Page 190 and 191:
Implications. Given the current pre
Page 192 and 193:
DiabetesPrevalence. Diabetes in chi
Page 194 and 195:
Limitations. The cross-sectional de
Page 196 and 197:
chronic lung disease, cystic fibros
Page 198 and 199:
significant differences between tho
Page 200 and 201:
Table 1. Prevalence of Selected Chr
Page 202 and 203:
findings of lower test scores are b
Page 204 and 205:
al (McKewen et al., 1998) report a
Page 206 and 207:
Section 3. School-Based Interventio
Page 208 and 209:
mathematics, science and oral expre
Page 210 and 211:
Table 4. Summary of Research Findin
Page 212 and 213:
etween SES and health is a dose-res
Page 214 and 215:
Self-Rated Health. Evidence accumul
Page 216 and 217:
economic hardship. One of the skill
Page 218 and 219:
Education also improves the stabili
Page 220 and 221:
sex in the expectation of a more pr
Page 222 and 223:
TABLE 6. SUMMARY OF EXPLANATIONS FO
Page 224 and 225:
According to the Census 2000 data,
Page 226 and 227:
Policy Reports Recommendations (Tot
Page 228 and 229:
Section 2. Recommendations on Schoo
Page 230 and 231:
Childhood ConditionsSchool-based Pr
Page 232 and 233:
Childhood ConditionsDiabetes (n=11)
Page 234 and 235:
eduction in reading test scores com
Page 236 and 237:
Table 10. Estimates of the Cost of
Page 238 and 239:
National Asthma Education and Preve
Page 240 and 241:
REFERENCESAck, M., Miller, I., & We
Page 242 and 243:
Elo, I. T., & Preston, S. H. (1996)
Page 244 and 245:
Kaemingk, K. L., Pasvogel, A. E., G
Page 246 and 247:
Miller, D. S., & Miller, T. Q. (199
Page 248 and 249:
Ross, C. E., & Wu, C. L. (1996). Ed
Page 250 and 251:
Williams, D. R. (1990). Socioeconom
Page 252 and 253:
SAMPLE, DESIGN, & INTERVENTIONACHIE
Page 254 and 255:
SAMPLE, DESIGN, & INTERVENTIONStudy
Page 256 and 257:
Page 258 and 259:
Page 260 and 261:
Page 262 and 263:
Page 264 and 265:
Page 266 and 267:
Page 268 and 269:
SICKLE CELL ANEMIAArmstrong(1996)SA
Page 270 and 271:
Page 272 and 273:
SAMPLE, DESIGN, & INTERVENTIONSickl
Page 274 and 275:
SAMPLE, DESIGN, & INTERVENTIONhemog
Page 276 and 277:
Page 278 and 279:
SAMPLE, DESIGN, & INTERVENTIONStudy
Page 280 and 281:
Curriculum Content: Statute §28.00
Page 282 and 283:
• HEALTH PROMOTING ENVIRONMENTSch
Page 284 and 285:
• COORDINATION/IMPLEMENTATIONCoor
Page 286 and 287:
Education and Health: A Review and
Page 288 and 289:
Appendix FState Regulation of Healt
Page 290 and 291:
coverage they offer. 14 By 2004 onl
Page 292 and 293:
poor health may make coverage more
Page 294 and 295:
account for most, or even much, of
Page 296 and 297:
More active state intervention in t
Page 298 and 299:
Table 3 (GAO Appendix IV) shows whi
Page 300 and 301:
Appendix GEmergency and Trauma Care
Page 302 and 303:
The treatment of shock prior to sur
Page 304 and 305:
the EMS needs in rural areas of the
Page 306 and 307:
Level IV trauma centers should be a
Page 308 and 309:
Table 2. Trends in Trauma Severity,
Page 310 and 311:
the hospitals were on diversion or
Page 312 and 313:
Representative Delisi was successfu
Page 314 and 315:
Mental Health Access ChallengesCare
Page 316 and 317:
fhttp://www.techproservices.net/his
Page 318 and 319:
oohttp://www.saveourers.org/reports
Page 320 and 321:
Appendix HBrief: Consulate ClinicDe
Page 322 and 323:
In addition, the roundtable discuss
Page 324 and 325:
clinic(s) affiliated with medical s
Page 326 and 327:
Appendix ICommon Abbreviations
Page 328 and 329:
HMOHRQOLHRSAICF/MRIHCTAIOMISSLBBLIU
Page 330 and 331:
Appendix JPresentersDate/Location:
Page 332 and 333:
Appendix KProvider Taxes: A Differe
Page 334:
were previously categorized as char
show all

COD E R E D

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

Delete template?

Save as template?