Health Policy Commons^™

An Analysis Of The Medicaid Imd Exclusion, Sara J. Rosenbaum, Joel B. Teitelbaum, D. Richard Mauery

Health Policy and Management Faculty Publications

This report examines the Medicaid Institutions for Mental Disease (IMD) exclusion, one of the very few instances in which federal Medicaid law prohibits federal contribution to the cost of medically necessary care furnished by licensed medical care providers to enrolled program beneficiaries. The report begins with a brief overview of Medicaid's role in financing care for conditions and illnesses classified as "mental diseases" under professional medical guidelines and the allocation of state and federal funding responsibilities under Medicaid. The report then reviews the elements of the Medicaid IMD exclusion, as well as key judicial and administrative rulings related to the …

Hipaa's Electronic Transactions Rule: Implications For Behavioral Health Providers, Brian Kamoie

Health Policy and Management Issue Briefs

On August 17, 2000, the Department of Health and Human Services (HHS) adopted uniform national standards for electronic health transactions and code sets pursuant to the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Uniform standards hold the promise of improved efficiency in the health care system through standardized electronic transmission of health information.

Many behavioral health care organizations (e.g., the American Psychiatric Association, the National Association of State Mental Health Program Directors, and the National Association of State Alcohol/Drug Abuse Directors) have argued that the Rule's standards are insufficient for behavioral health providers. …

How Care Is Managed: A Descriptive Study Of Current And Future Trends In Care And Cost Management Practices Under Private Sector Employee Benefit Plans, Phyllis Borzi, Marsha Regenstein, Lee Repasch, Soeurette Cyprien, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

In the fall of 2001, the United States Department of Health and Human Services' Office of the Assistant Secretary for Planning and Evaluation (ASPE) asked the Center for Health Services Research and Policy in the School of Public Health and Health Services, The George Washington University Medical Center, to undertake a descriptive study of the current and future trends in cost and care management techniques used in the employment-based health insurance marketplace. The purpose of this study was to identify and report on (1) the cost and care management techniques currently in use in the private sector by health plans …

State Eligibility Rules Under Separate State Schip Programs--Implications For Children's Access To Health Care, Sara Rosenbaum, Anne Rossier Markus

Health Policy and Management Issue Briefs

This Policy Brief is the fourth in a series of reports1 issued by the George Washington University Center for Health Services Research and Policy that examine the design of separately-administered State Children’s Health Insurance Programs (SCHIP) that is, programs that operate directly under the authority of the federal SCHIP statute rather than expansions of state Medicaid programs.2 These Policy Briefs also consider the implications of states’ design choices for children’s access to health care.

Behavioral Health And Managed Care Contracting Under Schip, Sara J. Rosenbaum, Colleen Sonosky, Karen Shaw, D. Richard Mauery

Health Policy and Management Issue Briefs

This Policy Brief examines behavioral health managed care contracting under separately administered State Children's Health Insurance Programs (SCHIP), i.e., programs that operate under the direct authority of Title XXI of the Social Security Act rather than as expansions of Medicaid. Most separate SCHIP programs buy managed care style health insurance for some or most of their enrolled children. Because Title XXI provides states with far greater administrative flexibility than Medicaid with respect to coverage and benefit design, provision of services, and administration of managed care arrangements, studying separate SCHIP managed care products sheds important light on how states might approach …

Health Coverage In Massachusetts: Far To Go, Farther To Fall, Sara J. Rosenbaum, Jeanne Lambrew, Peter Shin, Marsha Regenstein, Tanya Ehrmann, Dylan Roby

Health Policy and Management Faculty Publications

This analysis has been prepared to highlight the state's experience in health reform and describe the challenges that it now faces. It recommends a renewed commitment to maintaining and strengthening the reforms that have made Massachusetts one of the nation's health policy leaders. This analysis does not focus on comprehensive health reform, although we believe that the cost and coverage problems that plague the Massachusetts health system (as well as that of every other state) would be most effectively addressed through broader restructuring aimed at achieving universal coverage and more decisive control over expenditures. In this report, we instead focus …

Erisa Health Plans: Key Structural Variations And Their Effect On Liability, Phyllis Borzi

Health Policy and Management Faculty Publications

No abstract provided.

School-Based Health Centers And Managed Care Arrangements: A Review Of State Models And Implementation Issues, Jennel Harvey, Lissette Vaquerano, Lea Nolan, Colleen Sonosky

Health Policy and Management Faculty Publications

No abstract provided.

The Impact Of The State Children's Health Insurance Program (Schip) On Community Health Centers, Lea Nolan, Jennel Harvey, Karen Jones, Lissette Vaquerano, Ann Zuvekas

Health Policy and Management Faculty Publications

Nearly 12 million children in the United States do not have health insurance, and therefore often lack access to health care. In response, Congress enacted the State Children’s Health Insurance Program (SCHIP) in August 1997, the largest expansion of health insurance coverage since the inception of the Medicare and Medicaid programs. The SCHIP provides states with federal matching funds for children’s insurance either by expanding the existing Medicaid program, by creating a separate state program, or a combination of both.

The George Washington University’s Center for Health Services Research and Policy (CHSRP) was funded by the Health Resources and Services …

The Medicaid Buy-In Program: Lessons Learned From Nine "Early Implementer" States, Donna Folkemer, Allen Jensen, Robert Silverstein, Tara Straw

Center for Health Policy Research

For many individual Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) recipients, the risk of losing Medicaid coverage linked to their cash benefits is a powerful work disincentive. Eliminating barriers to health care and creating incentives to work can greatly improve financial independence and well being. To support this goal, Congress included a Medicaid Buy-In option in the Balanced Budget Act of 1997 and enacted the Ticket to Work and Work Incentives Improvement Act (TWWIIA) in 1999. These laws authorized states to create Medicaid Buy-In programs to extend Medicaid coverage to persons with disabilities who go to work. …

Policy Frameworks For Designing Medicaid Buy-In Programs And Related State Work Incentive Initiatives, Allen Jensen, Robert Silverstein, Donna Folkemer, Tara Straw

Center for Health Policy Research

This report provides policy frameworks to assist stakeholders (such as Medicaid directors, state legislators, and cross-disability coalitions) design and implement Medicaid Buy-In programs and related work incentive initiatives to enhance the level of economic self-sufficiency of persons with significant disabilities. Of particular focus of the paper are the design decisions affecting enrollment, costs, and a state's fiscal exposure.

The policy frameworks describe the interrelationships between federal and state cash assistance programs (particularly SSDI, SSI, and state SSI supplementation programs) and health entitlements (particularly the Medicaid program). The policy frameworks are derived from the experiences of the nine early implementation states …

Model Managed Care Contract For Health Professionals And Clinical Providers Of Mental Illness And Addiction Disorder Treatment And Prevention Services, Sara J. Rosenbaum, Joel B. Teitelbaum, Brian Kamoie, D. Richard Mauery

Health Policy and Management Faculty Publications

The contracting process is one that health care professionals oftentimes find complex and confusing. Furthermore, studies of managed care service contracts between managed care organizations and health professionals who furnish mental illness and addiction disorder prevention and treatment services have found that these contracts often heavily favor the managed care organization by allowing the MCO broad latitude over a network professional's service responsibilities, the rate of payment for covered benefits and extensive discretion over treatment decision-making.

As an aid to its members, the American Medical Association (AMA) has drafted a "model" provider agreement that gives physicians in both individual and …

Welfare Reform Reauthorization In 2002:What Are The Issues For Tribal Communities And Indian Families?, Kathleen A. Maloy

Health Policy and Management Issue Briefs

American Indian tribes have new options under the 1996 Welfare Reform legislation that created Temporary Assistance for Needy Families (TANF), a block grant enacted to replace the Aid to Families with Dependent Children (AFDC). TANF, which expires in September of this year, provides cash assistance to poor families with children, including poor American Indian Families, and gives tribes the option to design and administer their own family assistance programs following approval of the plan by the Department of Health and Human Services. As Congress considers TANF reauthorization, three new publications prepared for the Kaiser Family Foundation provide insight into the …

An Analysis Of Contracts For The Delivery Of Managed Behavioral Health Care Services In State Correctional Facilities, D. Richard Mauery, Joel B. Teitelbaum, Jeffrey Lerman, Sara J. Rosenbaum

Health Policy and Management Issue Briefs

This issue brief, prepared by the George Washington University Center for Health Services Research and Policy (CHSRP), presents an analysis of a sample of contractual agreements entered into by State Departments of Corrections with managed care organizations (MCOs) for the provision of managed behavioral health care services in State prisons. It is part of a series of contract studies undertaken by CHSRP that examine the implications of managed care contracting by public and private sector purchasers for the financing and delivery of behavioral health care services.

Child Development Programs In Community Health Centers, Sara J. Rosenbaum, Michelle Proser, Peter Shin, Sara E. Wilensky, Colleen Sonosky

Health Policy and Management Faculty Publications

This report, the third in a series that reviews federal health policy related to child development, examines the role of community health centers in providing child development programs for children age 3 and younger. It also presents an analysis of health centers using the Uniform Data System, a database maintained by the federal Bureau of Primary Health Care (BPHC) that contains user, utilization, and financial information on each reporting center. In addition, the report presents findings from a 2000 survey of four categories of child development programs at 79 health centers; examines the new prospective payment system for health centers …