Social and Behavioral Sciences Commons^™

The Devolution Of Managed Care Contractor Duties: Analysis And Implications For Public Policy In Managed Behavioral Health Care, Sara J. Rosenbaum, Anne R. Markus, Joel B. Teitelbaum

Health Policy and Management Issue Briefs

This Issue Brief analyzes the devolution of the legal duties assumed by managed care organizations (MCOs) in their contracts with group purchasers. Specifically, this brief examines the delegation of MCO contractual duties related to member care and services to individual network providers by comparing the language used in master contracts between purchasers and MCOs with the language contained in agreements with network health care providers who serve members covered under the master contract.

Access To Pediatric Services Under Medicaid Managed Care In The District Of Columbia, Karen Shaw, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

The Ticket To Work And Work Incentives Improvement Act Of 1999: Implications For The Design And Support Of Comprehensive Integrated Health Systems For Persons With Mental Illness And Addiction Disorder Disabilities, Sara J. Rosenbaum, Joel B. Teitelbaum, Brian Kamoie

Health Policy and Management Faculty Publications

This report is designed to provide an overview of the Medicaid provisions of the Ticket to Work and Work Incentives Improvement Act of 1999, Public Law 106-170. This report considers the implications of the Act for the design and support of comprehensive, Medicaid-financed systems of health care for workers with severe disabilities and impairments, with a specific focus on persons with mental illness and addiction disorder disabilities. The Act, described by advocates for persons with disabilities as the most important piece of disability-related legislation since the enactment of the Americans with Disabilities Act of 1990, expands the availability of health …

Olmstead V L.C.: Federal Implementation Guidelines, And Analysis Of Recent Cases Regarding Medicaid Coverage Of Long Term Care Services For Persons With Disabilities, Sara J. Rosenbaum

Health Policy and Management Issue Briefs

This analysis reviews the key elements of the United States Supreme Court's 1999 decision in Olmstead v L.C. as well as Federal implementation guidelines issued by the United States Department and Human Services. The Olmstead decision interprets the Americans with Disabilities Act ("ADA," PL 101-336), whose requirements apply to the use of all public funds. However, Medicaid represents the single largest source of public funding for both institutional and non-institutional services for persons with disabilities. As a result, when states expend Medicaid funds on care for persons with disabilities, two independent sets of legal requirements are triggered: those contained in …

The Devolution Of Managed Care Contractor Duties: Analysis And Implications For Public Policy In Managed Behavioral Health Care, Sara J. Rosenbaum, Anne R. Markus, Joel B. Teitelbaum, Marcie Zakheim, Michael Golde

Health Policy and Management Faculty Publications

This study, undertaken by the Center for Health Services Research and Policy at the George Washington University (GWU) School of Public Health and Health Services for the United States Department of Health and Human Services' Substance Abuse and Mental Health Services Administration, analyzes the devolution of the legal duties assumed by managed care organizations (MCOs) in their contracts with group purchasers. Specifically, this study examines the delegation of MCO contractual duties related to member care and services to individual network providers by comparing the language used in master contracts between purchasers and MCOs with the language contained in agreements with …

A Crosswalk Between The Final Hipaa Privacy Rule And Existing Federal Substance Abuse Confidentiality Requirements, Brian Kamoie, Phyllis Borzi

Health Policy and Management Issue Briefs

This Issue Brief provides an overview of and crosswalk between the Privacy Rule and the federal Confidentiality of Alcohol and Drug Abuse Patient Records statute, 42 U.S.C. § 290dd-2, and its implementing regulations at 42 C.F.R. Part 2 ("42 C.F.R. Part 2"). The crosswalk is intended to highlight the differences between the requirements of the Privacy Rule and 42 C.F.R. Part 2. In addition, this Issue Brief addresses the Privacy Rule's applicability to special populations and psychotherapy services provided by substance abuse paraprofessionals.

An Overview Of Legal Developments In Managed Care Caselaw And Selected Case Studies Of Legal Developments In State Contracting For Managed Behavioral Health Services, Sara J. Rosenbaum, D. Richard Mauery, Joel B. Teitelbaum

Health Policy and Management Issue Briefs

This analysis provides an overview of recent legal developments in managed care case law. Three types of cases are reviewed: claims brought by managed care enrollees against managed care companies and health plans; cases related either directly or indirectly to managed care and brought by both beneficiaries and managed care organizations against state Medicaid agencies and other public agencies engaged in the purchase of managed care; and cases brought by individual health professionals against managed care organizations.

Care Coordination And Physical And Behavioral Service Integration In Managed Care Contracts: Analysis And Sample Purchasing Specifications, Sara J. Rosenbaum, D. Richard Mauery, Brian Kamoie

Health Policy and Management Issue Briefs

This double Issue Brief on the issue of managed care contracts and care coordination has been prepared for the Substance Abuse and Mental Health Services Administration as part of a series that examines legal issues in managed care for persons with mental illness and addiction disorders. This Issue Brief is presented in two parts. Part 1 presents an analysis, based on managed care contract data bases developed by CHSRP, of the extent to which public and private group purchasers maintain agreements that specify care coordination as part of the standard of care for persons with co-occurring physical and/or behavioral illnesses …

State Benefit Design Choices Under Schip - Implications For Pediatric Health Care, Sara J. Rosenbaum, Anne Rossier Markus, Colleen Sonosky, Lee Repasch

Health Policy and Management Issue Briefs

This policy brief1 is the second in a series of reports focusing on the design of state SCHIP programs as they near full implementation. It examines the extent to which state agencies adopt conventional insurance norms or adhere to special principles of Medicaid coverage design for children in designing separately administered (or freestanding) SCHIP programs. The issue of coverage design is particularly relevant for children with low prevalence conditions and special health care needs. Increasingly, conventional insurance uses standardized coverage norms to limit coverage and treatment. These standardized norms take the form of across-the-board treatments and exclusions, limited definitions of …

Behavioral Health Benefits For Public Employees: Effect Of Mental Health Parity Legislation, Phyllis Borzi, Sara J. Rosenbaum

Health Policy and Management Issue Briefs

Recently, the Center for Health Services Research and Policy through a grant from the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services, examined contracts providing for mental health benefits for state employees in eight states to assess whether legislative attempts to require parity between physical and mental illnesses resulted in noticeable differences in behavioral health benefits for state employees.

We concluded that, except in states that have mandated full parity for some or all types of mental illnesses, behavioral health benefits for state employees have not changed significantly as a result of …

State Schip Design And The Right To Coverage, Sara J. Rosenbaum, Barbara Smith

Health Policy and Management Issue Briefs

No abstract provided.

How Can Health Serve As A Bridge For Peace? Certi Crisis And Transition Tool Kit, Rosalia Rodriguez-Garcia, James Macinko, F. Xavier Solorzano, Marita Schlesser, George Washington University School Of Public Health And Health Services

Global Health Faculty Publications

No abstract provided.