Health Services Administration Commons^™

Welfare Reform And Its Impact On Medicaid: An Update, Judith D. Moore

National Health Policy Forum

Welfare reform, enacted in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), had a profound impact on the Medicaid program, delinking Medicaid from the new TANF program and for the first time allowing Medicaid eligibility to be divorced from welfare status. This paper reviews the national impact of this decoupling, describing research, implementation activities, and the impact of new state welfare programs on health programs in general.

Biological Terrorism: Is The Health Care Community Prepared?, Robin J. Strongin

National Health Policy Forum

This issue brief provides an overview of biological warfare and discusses the role of the Centers for Disease Control (CDC) and state health departments in detecting biologic agents. The brief also highlights the issue of threat assessment and discusses ways to improve the current level of preparedness as well as steps needed to convert the public health system into our best form of civil defense.

Medicare Hmo Pullouts: What Do They Portend For The Future Of Medicare+Choice?, Nora Super

National Health Policy Forum

National policymakers became alarmed in the fall of 1998 when, contrary to expectations, nearly 100 Medicare HMOs announced their decisions to pull out of Medicare in certain areas or to reduce their service areas. This issue brief explores the reasons plans withdrew from certain areas, the Balanced Budget Act of 1997 provisions that most directly influenced these decisions, the impact of the withdrawals on Medicare beneficiaries, and policy options for ensuring the viability of the Medicare+Choice program.

Filling The Geriatric Gap: Is The Health System Prepared For An Aging Population?, Janet Firshein

National Health Policy Forum

This issue brief explores the field of geriatrics, the ways practitioners meet the health care needs of the elderly, training gaps, and the impact of Medicare payment policies on the delivery of health care to older Americans.

The Continuing Decline In Medicaid Coverage, Leighton Ku, Brian K. Bruen

Health Policy and Management Faculty Publications

No abstract provided.

Retooling Tax Subsidies For Health Coverage: Old Ideas, New Politics, Karl Polzer

National Health Policy Forum

This paper describes the tax treatment of health coverage and health care spending and explores the potential impact of recent tax reform proposals. The paper summarizes the criticisms of the current system and analyzes various alternatives including capping the open-ended tax exclusion of health benefits provided by employers and unions, eliminating the exclusion, and establishing a tax credit.

Physician Organizations Assuming Risk: Market And Policy Implications, Sandra Foote, Lisa Sprague

National Health Policy Forum

This issue brief looks at capitation contracting between physician groups and health plans and ways in which financial risk and functional responsibilities may be apportioned. It traces the evolution of capitation contracting in California and the legislative and regulatory issues that have arisen.

Site Visit To Southern California — Plans And Providers: Risk, Accountability, And Staying Power, Lisa Sprague

National Health Policy Forum

This site visit was the second of two focused on managed care operations and market dynamics in California, a state notable for high HMO market penetration and intense competition. In southern California, large physician groups and independent practice associations were highly visible and influential. They had assumed significant financial risk and care management responsibility for patients in HMO plans. The result was a distinctly different model of managed care than existed in other regions of the country. The visit included meetings with leaders from physician organizations and managed care organizations in San Diego and Orange counties, as well as an …

Site Visit To Utah And Nevada — Essential Community Health Services On The Frontier, Karen Matherlee, Michael Anzick

National Health Policy Forum

From the opening dinner to the closing summary, this site visit explored the delivery and financing of essential community services for vulnerable populations in the frontier West. A sequel to the Forum's March 30-31, 1998, urban-centered site visit to Philadelphia, Providing Community-Based Primary Care: Nursing Centers, CHCs, and Other Initiatives, the visit spanned 493 miles. It included overview presentations, bus briefings, facility tours, telehealth demonstrations, panel discussions, and wrap-up reviews. Topics included the Utah health marketplace, the demands of emergency preparedness, the development of a patchwork of services along a continuum ranging from preventive care to tertiary referrals and follow-up, …

The State Children's Health Insurance Program: How Much Latitude Do The States Really Have?, Richard Hegner

National Health Policy Forum

The State Children's Health Insurance Program (CHIP) — a major program to cover low-income, uninsured children — was passed as part of the Balanced Budget Act of 1997. Its passage was part of a trend of a shifting balance of power between the federal and state governments, particularly in the policy areas of health and social welfare. This issue brief explores the degree of freedom afforded the states by CHIP, the factors guiding state decision making and planning, and the factors influencing the states' various decisions about CHIP. It also discusses state options in four basic areas: participation or nonparticipation …

Protecting The Confidentiality Of Health Information, Nora Super

National Health Policy Forum

This issue brief focuses on the legislation aimed at protecting the confidentiality of health information. It provides an overview of legislation being considered in 1998 and focuses on three key issues: controlling access to health information, conducting research, and preempting state laws.

Communicating To Beneficiaries About Medicare+Choice: Opportunities And Pitfalls, Nora Super

National Health Policy Forum

This issue brief explores the opportunities and potential pitfalls in communicating to beneficiaries about Medicare+Choice. This issue brief also looks at the difficulties inherent in communicating complex information to a diverse group of older individuals as well as at communications and programmatic challenges related to information overload, marketing concerns, lack of uniform standards, lack of infrastructure, and the vulnerability of various subpopulations.

Medicare Coverage And Technology Diffusion: Past, Present, And Future, Robin J. Strongin

National Health Policy Forum

This issue brief provides an overview of the Medicare coverage process. Coverage involves deciding whether or not to pay for a particular service or product. This brief examines Medicare's coverage determination process, which includes technology assessment, payment determination, and the demand for evidence. Options for improving the coverage determination process are reviewed.

Erisa Health Plan Denials: Exploring Models For External Review, Karl Polzer

National Health Policy Forum

This paper outlines the current process under the Employee Retirement Income and Security Act (ERISA) by which plan participants can appeal a claim denial as well as changes to the claims procedure requirements being considered by the Department of Labor. It describes state legislative activity in this area and summarizes research describing practices currently in place among managed health care organization. The paper also describes two existing models for external review of managed care plan decisions, one used by the Medicare program and another by the state of Florida.

Site Visit To New Jersey — State And County Experiences With Welfare Reform And Access To Health Care, Michael Anzick, Richard Hegner

National Health Policy Forum

This site visit was the second in a series to examine what is occurring at the state and local level with respect to welfare reform, Medicaid, public health, and safety net and other supportive services. During this visit, policymaker discovered how state officials, directors, and front-line staff at urban and suburban county welfare offices are working with clients to move them off the welfare rolls into jobs and providing the support services necessary for job retention; heard from clients about how programmatic changes are affecting them and their families; learned how the role of safety net health care and temporary …

Dual Diagnoses: The Challenge Of Serving People With Concurrent Mental Illness And Substance Abuse Problems, Richard Hegner

National Health Policy Forum

This paper describes the prevalence of comorbid mental disorders in the population and discusses what is known about causality and relapse. The relationship between dual diagnosis and homelessness and crime is also discussed. The paper also explores options for improving treatment among the dually diagnosed.

Increasing The Federal Cigarette Tax: A Means Of Reducing Consumption?, Lauren Tran, Richard Hegner

National Health Policy Forum

This issue brief probes the economic issues associated with tobacco and cigarettes. It examines the possible effectiveness of a tax increase as a strategy to reduce cigarette consumption, especially among young people, and the likely ramifications of a tax increase for the tobacco industry.

Restructuring The Va Health Care System: Safety Net, Training, And Other Considerations, Barbara Skydell

National Health Policy Forum

This paper provides an historical overview of the modern Veterans Administration (VA) healthcare system and describes the multiple missions of the VA — patient care, health professions education, research, and medical preparedness. The VA's reform plan, which addresses issues related to decentralization, management and oversight, resource allocation, eligibility reform, and primary/ambulatory care, is also described and discussed. Challenges facing the VA as it transitions to a greater focus on prevention, primary care, and care management are also addressed.

The Federal Employees Health Benefits Program: What Lessons Can It Offer Policymakers?, Karl Polzer

National Health Policy Forum

This paper provides an historical overview of the Federal Employees Health Benefits (FEHB) program and its marketplace dynamics. It also reviews key program features and issues, including payments to health plans, strategies used to mitigate the opportunities for risk selection, and costs.

Site Visit To Philadelphia — Providing Community-Based Primary Care: Nursing Centers, Chcs, And Other Initiatives, Karen Matherlee

National Health Policy Forum

This site visit provided federal congressional and agency health staff opportunities to visit facilities and engage in discussions on essential community health services. Focused on community-based primary care in a managed care environment, it featured delivery and financing concerns relating to nursing centers, community health centers, public-mission hospitals, and homeless services. In examining the impact of managed care in a rapidly changing health marketplace, it explored the implementation of the Medicaid HealthChoices program in the city as well as access to and delivery of care to persons with neither public nor private insurance. It also looked at the role of …

Site Visit To Northern California — Risk, Accountability, And Staying Power In Next-Generation Managed Care, Lisa Sprague, Sandra Foote

National Health Policy Forum

This three-day site visit looked at private health insurance and delivery of care in a market notable for high managed care penetration, relatively low premium costs, and sophisticated provider groups. Federal congressional and regulatory staff heard from health insurance purchasers (both public and private), health plans, hospital systems, and physician groups about the changing relationships and accountabilities in this market and the ways various organizations were positioning themselves to survive the turmoil and emerge the stronger for it. Participants also heard from two county health programs about how competition and realignment in the private market were impacting safety-net services for …

Health Care Quality: From Data To Accountability, Mary Darby

National Health Policy Forum

This paper discussed the evolution of quality measurement and reporting activities as well as efforts to develop accountability for delivering high-quality care. It examined (a) initiatives in the professional arena, such as accreditation and performance measurement by independent accrediting bodies; (b) activities of market proponents, who have preferred to concentrate on making data available to purchasers and consumers that would enable them to choose high- quality plans and providers; and (c) attempts by the public sector to secure quality through regulation and oversight. An exploration of the successes, limitations, overlaps, and gaps in quality assurance initiatives, the paper was published …

Small Group Market Health Insurance Purchasing Cooperatives Revisited, Karl Polzer

National Health Policy Forum

As Congress was in the final stages of considering the Clinton administration's proposal for comprehensive health reform and various derivatives of it, this Forum session examined the progress of several purchasing cooperatives in helping employees of small firms find affordable insurance coverage. The first half of the meeting focused on California's purchasing alliance, especially its impact on prices in the small-group insurance market. Varying models of cooperatives (or alliances) being set up in Florida, Iowa, and Kentucky also were discussed, with special attention being paid to their potential for addressing fundamental problems such as rising costs and access to insurance.

Federal Support For Medical Education: Framing The Issues For The Systems Reform Debate, Karen Matherlee

National Health Policy Forum

Designed primarily for federal legislative and regulatory health staff involved in systems reform efforts, the session provided a primer on current medical education policies (with emphasis on federal strategies) and a prospectus on policies to change them.

Barriers To Attainment Of Health Care In West Central Maine : A Critique By The Poor, Health Facilities Planning Council

Maine Collection

Barriers to Attainment of Health Care in West Central Maine : A Critique by the Poor

"Conducted by the Health Facilities Planning Council, 11 Parkwood Drive, Augusta, Maine under contract to Maine Department of Health and Welfare, June, 1969."

Contents: Foreword / Table of Contents / Introduction / Map / Franklin County / Housing / Dental Rot / Franklin County Memorial Hospital / Family Planning / RN's / State Public Health Nurses / Unmet Health Needs / The Last Outpost / Home Visit in Farmington Falls / Home Visit in Industry / Home Visit in Rangeley Area / Conversations on …