Social and Behavioral Sciences 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.

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 …