Social and Behavioral Sciences Commons^™

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 …

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 …

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.