Health Policy Commons^™

Sub-State Purchasing Of Managed Behavioral Health Care: An Analysis Of County-Level Managed Care Contracts, Joel B. Teitelbaum, D. Richard Mauery, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

For this study, SAMHSA asked us to analyze county-level managed health care contracts that include behavioral health services. SAMHSA has indicated that sub-state entities, particularly counties, are beginning to explore the feasibility of contracting with managed care organizations, both to control costs and to improve coordination of services for the mental health or substance abuse systems they manage. In commissioning these various contract studies, SAMHSA was primarily interested in tracking the development of these new types of managed behavioral health care procurements and contracting practices, as well as determining whether there were exemplary commercial behavioral health provisions that could be …

An Analysis Of Implementation Issues Relating To Chip Cost-Sharing Provisions For Certain Targeted Low Income Children, Sara J. Rosenbaum, Anne Rossier Markus, Dylan Roby

Health Policy and Management Issue Briefs

This analysis, prepared for the Health Care Financing Administration and the Health Resources and Services Administration, examines issues that arise under laws designed to avert excessive cost-sharing in the case of low income families whose children participate in the State Children’s Health Insurance Program (CHIP). High cost-sharing has been shown to significantly affect children’s participation in insurance programs, as well as their utilization of health services. As a result, the Federal CHIP legislation, while permitting cost-sharing under certain circumstances, also places limitations on the total amount of cost-sharing to which families can be exposed for services covered by State CHIP …

Cultural Competence In Medicaid Managed Care Purchasing: General And Behavioral Health Services For Persons With Mental And Addiction-Related Illnesses And Disorders, Sara J. Rosenbaum, Joel B. Teitelbaum

Health Policy and Management Issue Briefs

This Issue Brief explores cultural competence. Employing the data base from the large-scale Medicaid contract analysis conducted annually by the Center for Health Services Research and Policy (CHSRP) (now CHPR), we examine the approaches that state agencies take in implementing the concept of cultural competence in the design and implementation of their managed care systems.

Diversion As A Work-Oriented Welfare Reform Strategy And Its Effect On Access To Medicaid: An Examination Of The Experiences Of Five Local Communities, Kathleen A. Maloy, Ladonna A. Pavetti, Julie S. Darnell, Peter Shin

Center for Health Policy Research

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) ended the individual entitlement to welfare benefits and gave states new flexibility to emphasize work instead welfare. PRWORA also severed the traditional eligibility link between Medicaid and welfare. This research examined the emergence of diversion programs as a particular aspect of state welfare reform efforts and the potential for diversion programs to reduce access to Medicaid. In this second of two reports, we present the results of case studies in five states.

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

Health Policy and Management Faculty Publications

No abstract provided.

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 …

Congress Crafts Child Health Insurance Program, George Washington University Medical Center, Center For Health Policy Research

Center for Health Policy Research

No abstract provided.

An Evaluation Of Contracts Between Managed Care Organizations And Community Mental Health And Substance Abuse Treatment And Prevention Agencies, Sara J. Rosenbaum, Karen Silver, Elizabeth Wehr

Health Policy and Management Faculty Publications

This study represents a descriptive, point-in-time examination of the structure and content of provider network agreements between managed care organizations (MCOs) and community mental health and substance abuse (MH/SA) treatment and prevention agencies. This is not a study of the quality of managed care systems. Instead, this analysis is designed to assess provider contracts (one of the basic legal instruments on which the managed care system rests) and to identify the meaning of these instruments for MH/SA service providers, group purchasers, MCOs, individual consumers and their families, and public policy.

Integrating Indian Health Programs Into Medicaid Managed Care Systems, Part 2, Sara J. Rosenbaum, Ann Zuvekas

Center for Health Policy Research

The Indian Health Service (IHS), recognizing that state Medicaid programs are rapidly purchasing managed care plans for their beneficiaries and that managed care enrollment has significant implications for both Indians and Indian health facilities, convened this Roundtable to discuss options for participation in such care. The purpose of this roundtable was to identify options to increase Medicaid managed care participation by Indian health programs. These include programs operated directly by IHS, programs operated by tribes under the Indian Self-Determination Act, and urban Indian programs under Title V of the Indian Health Care Improvement Act.By design, Roundtable participants were a group …

Integrating Indian Health Programs Into Medicaid Managed Care Systems, Part 1, Sara J. Rosenbaum, Ann Zuvekas

Center for Health Policy Research

The Indian Health Service (IHS), recognizing that state Medicaid programs are rapidly purchasing managed care plans for their beneficiaries and that managed care enrollment has significant implications for both Indians and Indian health facilities, convened this Roundtable to discuss options for participation in such care. The purpose of this roundtable was to identify options to increase Medicaid managed care participation by Indian health programs. These include programs operated directly by IHS, programs operated by tribes under the Indian Self-Determination Act, and urban Indian programs under Title V of the Indian Health Care Improvement Act.By design, Roundtable participants were a group …

Child Health Supervision: Analytical Studies In The Financing, Delivery, And Cost-Effectiveness Of Preventive And Health Promotion Services For Infants, Children, And Adolescents, Michele R. Solloway, Peter Budetti

Center for Health Policy Research

Contents: Financing and Delivery of Child Health Supervision Services (An Overview of Health Insurance Coverage and Access to Child Health Supervision Services, Private Health Insurance Coverage of Preventive Benefits for Children, A 20-Year Retrospective of Child Health Supervision in Ambulatory Pediatric Settings, Ensuring Adequate Health Care Benefits for Children and Adolescents); Child Health Supervision Services and Medicaid (Informing State Medicaid Providers about EPSDT, Barriers to Full Participation in EPSDT and Possible Strategies for the Maternal and Child Bureau, Medicaid Managed Care: A Briefing Book on Issues for Children and Adolescents; State Implementation of OBRA '89 EPSDT Amendments within Medicaid Managed …