Health Policy Commons^™

Selected Key Issues In The Development And Drafting Of Public Managed Behavioral Health Care Carve-Out Contracts, Joel B. Teitelbaum, Sara J. Rosenbaum, William Burgess, Leilani Decourcy

Health Policy and Management Issue Briefs

The development of managed behavioral health care carve-out contracts covering a discrete subset of benefits available for use by persons with mental health and/or substance abuse disorders poses major challenges for public purchasers. This Issue Brief explores several key issues that arise when drafting such agreements. Many of the issues that arise in the drafting of carve-out agreements will require the public purchaser to resolve basic policy questions well before the drafting of requests for proposals or contracts can proceed.

An Overview Of Medicaid Managed Care Litigation, Sara J. Rosenbaum, Joel B. Teitelbaum, Christopher Kirby, Linda Priebe, Tal Klement

Health Policy and Management Issue Briefs

This Issue Brief is intended as one of several in the Managed Behavioral Health Care Issue Brief Series that deals with managed behavioral health care from a purely legal point of view.

Since the enactment of Medicaid in 1965, states have had the option of offering beneficiaries enrollment in managed care arrangements. With the advent of mandatory managed care reaching millions of beneficiaries (including a growing proportion of disabled recipients), the amount and scope of litigation involving Medicaid managed care plans can be expected to grow. A review of the current litigation regarding Medicaid managed care reveals two basic types …

Medicaid Managed Care Contracting For Childhood Lead Poisoning Prevention Services, Elizabeth Wehr, Sara J. Rosenbaum

Center for Health Policy Research

This study reports on provisions relating to childhood lead poisoning prevention services in Medicaid managed care contract documents (service agreements and requests for proposals, RFPS). The provisions were extracted from the managed care contracts data base of the Center for Health Policy Research of the George Washington University Medical Center. The data base was constructed and is updated as part of the Center's ongoing analytic studies.' As with other Center studies of the contract documents, this is a descriptive study of how state Medicaid agencies addressed a series of contracting issues at a specific point in time.* In brief, we …

Coverage Decision-Making In Medicaid Managed Care: Key Issues In Developing Managed Care Contracts, Sara J. Rosenbaum, Joel B. Teitelbaum

Health Policy and Management Issue Briefs

Coverage provisions are the most complex part of any managed care contract. This is particularly true for Medicaid agencies, because of important differences between Medicaid and insurance. This Issue Brief identifies general issues that should be addressed as managed care contracts are developed and drafted, and it specifically explores the challenges faced by public purchasers when drafting managed care coverage provisions.

Institutional Design And Regulatory Performance: Rethinking State Certificate Of Need Programs, Robert B. Hackey, Peter F. Fuller

Health Policy & Management Faculty Publications

The success of state efforts to control rising health care costs depends on the incentives contained in the legislative design of regulatory policies and in the administrative capacity and autonomy of state agencies. States have regulated the construction and expansion of health care facilities and services for more that two decades through “certificate of need” (CON) programs designed to limit the diffusion of expensive new medical technologies and to avoid the duplication of health care facilities. Although the cost-control record of state certificate of need programs has been widely criticized, Rhode Island’s experience with a reformed CON process from 1985 …

Mental Illness And Addiction Disorder Treatment And Prevention, Sara J. Rosenbaum, Peter Shin, Marcie Zakheim, Karen Shaw, Joel B. Teitelbaum, Kay Johnson

Health Policy and Management Faculty Publications

This Special Report of Negotiating the New Health System: A Nationwide Study of Medicaid Managed Care Contracts (2d Ed.) analyzes Medicaid managed care contract provisions related to mental illness and addiction disorders (MI/AD). The analysis is based on 54 contracts and related documents (including 12 managed behavioral health care contracts) which were in effect as of the beginning of 1997. While this Special Report considers Medicaid contracts, its findings have implications for other public purchasers of managed care services for persons with MI/AD because, like Medicaid, other sources of third-party financing have traditionally supported services and activities that may not …

Mozambique: A Listing Of Organizations Conducting Humanitarian Demining/Mine Awareness Activities, Cisr

CISR Studies and Reports

The following list describes organizations that have been active in conducting humanitarian demining activities in Mozambique. The list includes NGO’s, IO’s, commercial firms, governmental and military organizations. Printouts for some organizations with websites are included in Appendix A and are coded with an asterisk in the list.

Patients As Consumers: Making The Health Care System Our Own., David J. Lansky

Center for Policy Research

I ask you to think about our health care system. Think beyond the issues that are in front of us today: the anxiety we have about managed care, obtaining our own health care and paying for it, the survival of Medicare, and the unpredictable impact of government regulations. Think about our *health*, what we want from our health care system, what we're spending all this money for, and what we care about for ourselves and for our families. The challenge we face in the next five, ten, or fifteen years is to place the American health care system under the …

Mozambique Mine Awareness Education Module, Cisr

CISR Studies and Reports

Mine Awareness Education Module - Mozambique is based on information acquired through a variety of expert sources. The document incorporates information gathered through

• a review of ecological theories,

• an extensive review of existing humanitarian demining mine awareness and prevention programs,

• a review of effective strategies of community-change efforts,

• and interviews with persons conducting mine awareness programs in Mozambique and other sub-Sahara countries.

In addition, interviews and briefings were conducted with personnel from the Office of the Assistant Secretary of Defense, Special Operations/Low Intensity Conflict, US. Army Special Operations Command, 4th Psychological Operations Group and Special Operations …

New Conundrums: Public Policy And The Emerging Health Care Marketplace, James R. Tallon

Center for Policy Research

There is a fundamentally new dynamic in American health care, one that has yet to be fully experienced but that threatens to leave a large portion of the American population without access to the quality health care they have received in the past. While the federal government has not completely abandoned the goal of assuring universal health care, a goal that dates back to the creation of Medicare and Medicaid in the 1960s and even earlier, the mechanisms to pursue that goal have changed. The implicit contract between government and health care providers--mostly doctors and not-for-profit hospitals--under which subsidized care …

Rights And Efficiency In American Health Law, Maxwell Gregg Bloche

Georgetown Law Faculty Publications and Other Works

During the 1960s and 1970s, the individual rights revolution that swept through American society remade much of the nation's health law in its image. Sick people acquired the right to be told of the risks and benefits of proposed treatments and then to give thumbs-up or thumbs-down to their doctors' decisions. Successful suits for medical negligence went from rare to commonplace. Elderly and poor Americans achieved statutory rights of access to publicly funded healthcare, and courts burnished these rights with myriad procedural protections. The critically ill and their families won the right to refuse aggressive, life-sustaining treatments. Psychiatric patients acquired …

Who May Give Birth To Citizens? Reproduction, Eugenics, And Immigration, Dorothy E. Roberts

All Faculty Scholarship

No abstract provided.

Governance And Hiv - Government-Civil Society Interface: An Aspect Of Governance Critical To An Effective Response, Fernando T. Aldaba, Josefa Petilla

Economics Department Faculty Publications

There exists a dynamic interrelationship between good governance, a successful government organisation (GO) - civil society organisation (CSO) interface and an appropriate response to the HIV-AIDS epidemic. Good governance creates an environment that promotes collaboration among various sectors of society. Appropriate response to the epidemic, on the other hand, are engendered by positive interfaces and cooperation between key sectors of a community. The case study will specifically examine three examples of interface: the Philippine National AIDS Council (PNAC) at the national level; and for the local implementation, Olongapo city, and the province of Palawan.

Characteristics of good governance that promote …