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Full-Text Articles in Health Policy
Medicare Advantage Payment Provisions: Health Care And Education Affordability Reconciliation Act Of 2010 H.R. 4872, Brian Biles, Grace Arnold
Medicare Advantage Payment Provisions: Health Care And Education Affordability Reconciliation Act Of 2010 H.R. 4872, Brian Biles, Grace Arnold
Health Policy and Management Issue Briefs
The Health Care and Education Affordability Reconciliation Act of 2010 would make major changes to Medicare Advantage (MA) payment policies. Overall, payments to MA plans would be reduced from the current national average of 113 percent of local fee-for-service (FFS) costs to a new average of 101 percent of FFS costs. The Congressional Budget Office (CBO) has estimated that the new polices would reduce Medicare spending by $132 billion over 10 years. The new policies would set county payment benchmarks for MA plans at 115 percent, 107.5 percent, 100 percent, and 95 percent of local FFS costs depending of 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
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.
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
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.
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
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.
Medicare, Managed Care, And Behavioral Health Care, Sara J. Rosenbaum, Barbara Markham Smith
Medicare, Managed Care, And Behavioral Health Care, Sara J. Rosenbaum, Barbara Markham Smith
Health Policy and Management Issue Briefs
This issue brief examines Medicare and managed care for Medicare beneficiaries with behavioral health needs. Although only a relatively small proportion of Medicare beneficiaries are enrolled in managed care arrangements at the present time, proposals to expand the use of Medicare managed care can be expected to receive a good deal of attention in the coming years as part of a larger debate over Medicare's long term future. Thus, this issue brief examines the Medicare+Choice (M+C) program from the perspective of Medicare beneficiaries with mental illness and addiction disorders.
Coverage Decisions Versus The Quality Of Care: An Analysis Of Recent Erisa Judicial Decisions And Their Implications For Employer-Insured Individuals, Sara J. Rosenbaum, Joel B. Teitelbaum
Coverage Decisions Versus The Quality Of Care: An Analysis Of Recent Erisa Judicial Decisions And Their Implications For Employer-Insured Individuals, Sara J. Rosenbaum, Joel B. Teitelbaum
Health Policy and Management Issue Briefs
This Issue Brief, prepared for the Substance Abuse and Mental Health Services Administration, examines the evolution of this framework for analyzing health claims emanating from the conduct of ERISA-covered managed care arrangements and considers its implications for the provision of treatment for mental illness and addiction disorders. Both studies and anecdotal evidence suggest that managed care companies impose particularly rigorous controls over treatment for mental illness and addiction disorders. It is therefore perhaps not surprising that legal challenges to treatment decisions frequently involve individuals with these conditions. Consequently, to the extent that courts are in fact on the verge of …
The Americans With Disabilities Act: Implications For Managed Care For Persons With Mental Illness And Addiction Disorders, Sara J. Rosenbaum, Joel B. Teitelbaum, Robert Silverstein
The Americans With Disabilities Act: Implications For Managed Care For Persons With Mental Illness And Addiction Disorders, Sara J. Rosenbaum, Joel B. Teitelbaum, Robert Silverstein
Health Policy and Management Issue Briefs
This Issue Brief, prepared for the Substance Abuse and Mental Health Services Administration, examines the Americans with Disabilities Act ("the ADA") and its application to managed care. The ADA provides important protections for persons with disabilities who are members of managed care arrangements, regardless of whether their membership is sponsored by an employer, Medicare, or Medicaid or is purchased privately. The interaction between the ADA and managed care is complex, and different issues can arise under publicly and privately sponsored plans.