Health Policy Commons^™

Toward Improved Support For Research On Delivery Of Home- And Community-Based Long-Term Care, Francis G. Caro

Gerontology Institute Publications

Stronger and more consistent support is needed for research on long-term care. A greater investment in research will strengthen the ability of public and private organizations to provide effective and efficient assistance to people with disabilities and their informal caregivers. This paper provides a rationale for stronger research funding for the field and outlines several options to strengthen research.

Developmental, Psychosocial, And Economic Predictors Of Healthy Newborns In Michigan’S Teenage Pregnancies, Cheryl Lauber

Dissertations

Teenage pregnancy is a critical health indicator. Using a risk reduction model, this study examined the relationship between the characteristics o f the teenage mother i and her newborn. The research questions were: ( I) what risk factors are associated with poor birth outcomes, (2) is addressing each factor the best way to reduce the risk, and (3) has the overall risk changed as the birth rate has declined? Developmental, psychosocial and economic risks were identified as independent variables, while age and race were mediators.

Combining the birth certificate records of women under age 20 from 1990 through 1997 resulted …

Pegram V Herdrich: Implications For Consumer Protections In Managed Care, Sara J. Rosenbaum, Joel B. Teitelbaum

Health Policy and Management Faculty Publications

This Report, prepared for the Substance Abuse and Mental Health Services Administration, provides a brief overview of the United States Supreme Court's landmark decision in Pegram v Herdrich (hereinafter referred to as Herdrich). This report begins with a brief overview of the debate in the courts over how to distinguish between legal challenges to the conduct of managed care companies in which all state remedies are preempted by ERISA and those that may proceed under state law. It then summarizes the facts of the Herdrich case and the Court's holding. The report concludes with a discussion of the implications of …

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.

The Americans With Disabilities Act And Academic Libraries In The Southeastern United States, Linda Lou Wiler, Eleanor Lomax

E-JASL 1999-2009 (Volumes 1-10)

Individuals with disabilities are one of the fastest-growing segments of United States society. In 1970, 11.7% of the United States population was limited in activity, a major factor in measuring and identifying people with disabilities. In 1990, because of the aging of America, 13.7 % of the population could be so identified. By 1994, 15% of the population fell into this group. During this latter period, the older population stayed fairly stable but children and younger adults with disabilities increased greatly. Many different figures, depending upon the method of counting, e.g., age groups included, or whether residence was in a …

Understanding Medicaid Home And Community Services: A Primer, Gary Smith, Janet O'Keeffe, Letty Carpenter, Pamela Doty, Brian Burnwell, Robert Mollica, Loretta Williams, George Washington University, Center For Health Policy Research

Center for Health Policy Research

No abstract provided.

Caring To Death: Health Care Professionals And Capital Punishment, Cary H. Federman, Dave Holmes

Department of Justice Studies Faculty Scholarship and Creative Works

The aim of this article is to describe the role of health care professionals in the capital punishment process. The relationship between the protocol of capital punishment in the United States and the use of health care professionals to carry out that task has been overlooked in the literature on punishment. Yet for some time, the operation of the medical sciences in prison have been `part of a disciplinary strategy' `intrinsic to the development of power relationships'. Many capital punishment statutes require medical personnel to be present at, if not actively involved in, executions. Through analyses of these statutes, show …

Report On The Minors’ Abortion Rights Project, J. Shoshanna Ehrlich, Carol Hardy-Fanta, Jamie Ann Sabino

Publications from the Center for Women in Politics and Public Policy

The goal of this study was to learn more about the experience of minors in states with parental involvement laws who do not involve their parents in their abortion decision, and must therefore seek judicial authorization for an abortion, and to use this knowledge to explore ways to minimize the burden of these laws. At the outset, it should be made clear that having this goal does not indicate that we support imposing third-party involvement requirements on teens seeking to abort. Our research, as well as the work of others (much of which is cited in this report), raises serious …

U.S Peak And Non-Peak Hyperthermia: Who Is At Risk, Susan M. Macey

RISK: Health, Safety & Environment (1990-2002)

The author examines hyperthermia death rates in the United States from 1979 to 1996 to determine the relative risk for different demographic groups during peak years for heat-related deaths and for nonpeak years.

Making Sense Of Medicaid Reform, Robert B. Hackey

Health Policy & Management Faculty Publications

Reviews the books 'Medicaid Reform and the American States: Case Studies of Managed Care,' by Mark Daniels and 'Remaking Medicaid: Managed Care for the Public Good,' by Stephen Davidson and Stephen Somers.

Optional Purchasing Specifications For Child Development Services In Medicaid Managed Care, George Washington University Medical Center, Center For Health Services Research And Policy

Center for Health Policy Research

These sample purchasing specifications were prepared by the George Washington University Center for Health Services Research and Policy (CHSRP) with support from the Commonwealth Fund. Technical guidance on the content of child development services was provided by experts from the Fund and researchers at Northwestern University’s Institute for Health Services Research & Policy Studies (IHSRPS). This document is intended as a tool to assist interested state officials in purchasing child development services from managed care organizations (MCOs) on behalf of children under age three who are eligible for Medicaid.

These sample purchasing specifications are optional, and do not necessarily reflect …

Beyond Stigma: What Barriers Actually Affect The Decisions Of Low-Income Families To Enroll In Medicaid?, Jennifer P. Stuber, Kathleen A. Maloy, Sara Rosenbaum, Karen C. Jones

Health Policy and Management Issue Briefs

No abstract provided.

Mental Illness And Addiction Disorders And Medicaid Managed Care, Sara J. Rosenbaum, Joel B. Teitelbaum, D. Richard Mauery

Health Policy and Management Faculty Publications

This Special Report on mental illness and addiction disorders is part of Negotiating the New Health System: A Nationwide Study of Medicaid Managed Care Contracts, now in its third edition. Negotiating the New Health System is a nationwide point-in-time study of agreements between state Medicaid agencies and managed care organizations (MCOs) offering general or specialized managed behavioral health care products. Each individual edition of Negotiating the New Health System is a point-in-time study or "snapshot" of these agreements for a particular year. However, the current series of editions, taken together, are beginning to form a longitudinal basis for reviewing the …

The Rural Hospital Dilema: Will Nevada’S Rural Hospital System Survive?, Nancy L. Anderson

UNLV Theses, Dissertations, Professional Papers, and Capstones

This study, prepared for the Department of Public Administration, will review and discuss the rural hospitals in the State of Nevada. By virtue of its size and population distribution, Nevada has a need for rural hospitals. These hospitals, which are of critical importance for Nevada residents, are constantly struggling with how to build and support their limited health system capacity and infrastructure. To survive, rural hospitals must offset the losses they have sustained as a result of decreased federal funding. Some ways these losses have been offset is by employing some of the programs created by the Balanced Budget Act …

Mental Health Parity: National And State Perspectives 2000: A Report To The Florida Legislature, Bruce Lubotsky Levin, Ardis Hanson, Richard Coe, Sara A. Kuppin

Ardis Hanson

By failing to appropriately treat adults and children with severe mental illness, we incur enormous social costs through payments for disability benefits (Medicaid, SSI, SSDI), increased medical expenses, accidents and suicides, avoidable criminal justice proceedings, lost productivity, and increased need for homeless shelters and services. People who are underinsured are forced by arbitrary caps and limits to increasingly rely on the public sector. By providing parity for mental health, Florida will bring mental health into the mainstream of health care and become a leader in dispelling the prejudice that surrounds treatment of persons with severe mental illness.

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 …

Providing Low-Cost Assistive Equipment Through Home Care Services: The Massachusetts Assistive Equipment Demonstration, Alison S. Gottlieb, Francis G. Caro

Gerontology Institute Publications

This report describes the Massachusetts Assistive Equipment Demonstration, a collaborative project funded by the Robert Wood Johnson’s Home Care Research Initiative and carried out collaboratively by the Gerontology Institute at the University of Massachusetts Boston and the Executive Office of Elder Affairs (EOEA). The purpose of the demonstration was to systematically encourage the use of low-cost assistive equipment among elderly clients through existing case management resources, thereby extending the effectiveness of the Massachusetts home care program by supplementing formal services with expanded use of assistive equipment.

Nursing Homes To Medicare Waiver Programs In Vermont, Joseph Murray

New England Journal of Public Policy

This research examines the differences between nursing home residents and those who were able to leave nursing homes with the help of the Medicaid Waiver Program in Vermont. Ninety individuals who reentered the community with the aid of such waivers were compared with a random sample of nursing home residents through the use of the Nursing Home Minimum Data Set. The researchers found divergence in four key areas: cognition, continence, treatment categories, and desire to return to the community. Typically, those who left nursing homes for the community were cognitively intact, had moderate continence, received rehabilitative or clinically complex treatments, …

An Evaluation Of Agreements Between Managed Care Organizations And Community-Based Mental Illness And Addiction Disorder Treatment And Prevention Providers, Sara J. Rosenbaum, Joel B. Teitelbaum, D. Richard Mauery, Marcie Zakheim, Michael Golde

Health Policy and Management Issue Briefs

This Issue Brief, prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), examines contracts between managed care organizations (MCOs) and community-based providers of mental illness and addiction disorder treatment and prevention services (MI/AD providers). Building upon initial research published in 1997, this brief explores in depth one of the most hidden aspects of managed care: the relationship between the managed care organizations and health care providers.

Designing A Complaint And Grievance System And Other Member Assistance Services Under Medicaid Managed Care, Sara J. Rosenbaum, Joel B. Teitelbaum

Health Policy and Management Issue Briefs

Medicaid beneficiaries enrolled in managed care arrangements have two basic sets of procedural protections when benefits are denied. The first set consists of the right to timely and adequate notice of "any action affecting [a] claim" for medical assistance, as well as a fair hearing in the case of any individual "whose claim for medical assistance under the plan is denied or is not acted upon with reasonable promptness." The second is the right to "internal grievance" procedures to "challenge the denial of coverage *** or payment [of medical] assistance." The Health Care Financing Administration (HCFA) is expected to delineate …

Health Centers' Role As Safety Net Providers For Medicaid Patients And The Uninsured, Sara J. Rosenbaum, Peter Shin, Anne R. Markus, Julie S. Darnell, Rachel Garfield, David Rousseau

Health Policy and Management Faculty Publications

In order to understand the role of health centers as safety net providers, as well as the potential impact of these trends, this issue paper provides an in-depth examination of federally-funded health centers. Using data from the Uniform Data System (UDS), a government-maintained system that collects extensive patient, revenue, and service data on a calendar-year basis from health centers that receive federal grants, this issue paper profiles federally-funded health centers. It presents information on health center patients and revenue sources and analyzes similarities and differences both between health centers and private practices and among health centers. Health centers perform a …

The Politics Of Reform, Robert B. Hackey

Health Policy & Management Faculty Publications

Comments on the implication of individual health insurance market reform for policy making in the United States. Role of competitive markets in promoting access to health care; Notion on the rejection of enrollment and rating claims; Effectiveness of incremental reforms in limiting discrimination against high-risk subscribers.

Effect Of The 1996 Welfare And Immigration Reform Laws On Immigrants' Ability And Willingness To Access Medicaid And Health Care Services, George Washington University, Center For Health Services Research And Policy

Center for Health Policy Research

No abstract provided.

Medicaid, Managed Care, And Kids. 12th Annual Herbert Lourie Memorial Lecture On Health Policy, Deborah A. Freund

Center for Policy Research

This policy brief talks about what managed care for Medicaid is, how it influences kids, and how it relates to the State Child Health Insurance Program (CHIP). It focuses on what we have learned over the last 20 years through research about cost, use, and quality. It also discusses some of the expectations we had for children covered by Medicaid managed care. Finally, it talks about the future of Medicaid managed care and the implications for CHIP.

Does Chronic Illness Affect The Adequacy Of Health Insurance Coverage?, Kevin T. Stroupe, Eleanor D. Kinney, Thomas J. Kniesner

Center for Policy Research

Although chronically ill individuals need protection against high medical expenses, they often have difficulty obtaining adequate insurance coverage due to medical underwriting practices used to classify and price risks and to define and limit coverage for individuals and groups. Using data from healthy and chronically ill individuals in Indiana, we found that illness decreased the probability of having adequate insurance, particularly among single individuals. Chronic illness decreased the probability of having adequate coverage by about 10 percentage points among all individuals and by about 25 percentage points among single individuals. Pre-existing condition exclusions were a major source of inadequate insurance. …

Chronic Disease: The Epidemic Of The Twentieth Century, Dora Anne Mills

Maine Policy Review

One hundred years ago, the leading causes of death were infectious diseases such as tuberculosis, influenza and pneumonia. Of equal concern were water-borne diseases such as cholera and typhoid. Yet today, as a result of public health measures to clean up drinking water and provide immunizations, and by improvements in medical care, such diseases have been eradicated. As Dora Anne Mills points out, as we begin a new century, we have much to celebrate but still more to consider. Today, we face an epidemic unlike any found in 1900. One hundred years ago only one-in-six people died of a chronic …

Adolescent Girls' Livelihoods. Essential Questions, Essential Tools: A Report On A Workshop [Arabic], Carey Meyers

Poverty, Gender, and Youth

This report, co-published by the Population Council and the International Center for Research on Women, describes a workshop convened in Cairo in 1999 to learn more about the nature of both younger and older adolescents' work experience, differentiate the particular needs and potentials of adolescent girls, and identify programs and policies that might have promise for supporting them.