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Strengthen the Evidence for Maternal and Child Health Programs

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Items in this list may be obtained from the sources cited. Contact information reflects the most current data about the source that has been provided to the MCH Digital Library.

Displaying records 1 through 7 (7 total).

Fox HB, Limb SJ, McManus MA, Levtov RG. 2005. An analysis of states' capitation methods and pediatric rates, 1997-2003. Washington, DC: Maternal and Child Health Policy Research Center, 34 pp. (Medicaid Managed Care Trends Project: Issue brief; no. 5)

Annotation: This issue brief provides a snapshot of the methods states used to set their pediatric capitation rates at the end of 2003 and the amounts they paid to managed care organizations for both TANF (Temporary Assistance to Needy Families)-related children and children who qualified as SSI (Supplemental Security Income program) -related eligibles. It also provides an analysis of the extent to which these methods and amounts changed over the three-year period from 1997 to 2003. The appendices contain extensive tables and figures presenting detailed statistics. [Funded by the Maternal and Child Health Bureau]

Contact: Maternal and Child Health Policy Research Center, 750 17th Street, N.W., Suite 1100, Washington, DC 20006-4607, Telephone: (202) 223-1500 Fax: (202) 496-9067 Available from the website.

Keywords: Capitation rates, Child health services, Children with special health care needs, Health care costs, Managed care, State programs

Holahan J. 2003. Survey of children's health insurance program managed care capitation rates. Lawrenceville, NJ: Center for Health Care Strategies, 35 pp.

Annotation: This paper provides data on payment methods and capitation rates used by State Children's Health Insurance Programs (SCHIPs) as of January 2002. The paper, which includes an executive summary, also contains the following sections: (1) survey design, (2) payment methods, (3) capitation rate adjustments, (4) rate standardization methodology, (5) payment rates, (6) comparisons with Medicaid capitation rates for children, and (7) conclusion. Extensive statistical information is presented in tables grouped together in an appendix.

Contact: Center for Health Care Strategies, 300 American Metro Boulevard, Suite 125, Hamilton, NJ 08619, Telephone: (609) 528-8400 Fax: (609) 586-3679 Web Site: http://www.chcs.org Available from the website.

Keywords: Capitation rates, Data, Medicaid, State Children', Surveys, s Health Insurance Program

Fox H, Limb SJ, Chen CY, Hayden MS. 2000. An analysis of States' Medicaid managed care plan arrangements and service requirements affecting children, 1995–1999. Washington, DC: Maternal and Child Health Policy Research Center, 25 pp. (Medicaid Managed Care Trends project: Issue brief; no. 2)

Annotation: This report is the second in a series analyzing state Medicaid managed care trends. It provides an analysis of plan arrangements and coverage requirements in effect at the end of 1999 and of the extent to which these requirements changed in the five year period from 1995 to 1999. It examines both general and specialized plan arrangements and the scope of capitated services and contractual requirements governing the EPSDT benefit. Tables at the end of the report show by state (1) types of managed care organizations used by state Medicaid agencies, (2) services carved out of fully capitated contracts in 1999, and (3) EPSDT language regarding diagnosis and treatment in fully capitated contracts in 1999. Additional tables show types of managed care organizations used by Medicaid agencies from 1997 to 1999, services carved out of fully capitated contracts from 1995 to 1999, and EPSDT language regarding diagnosis and treatment in fully capitated contracts from 1995 to 1999. [Funded by the Maternal and Child Health Bureau]

Contact: Maternal and Child Health Policy Research Center, 750 17th Street, N.W., Suite 1100, Washington, DC 20006-4607, Telephone: (202) 223-1500 Contact Phone: (202) 223-1500 Fax: (202) 496-9067 Contact E-mail: [email protected] $35.00.

Keywords: Capitation rates, Child health, Children, Contract services, EPSDT, Medicaid managed care, State health insurance programs, Statistics

Fox HB, McManus MA, Almeida RA. 1997. Current policies and future directions in state Medicaid managed care arrangements for children. Washington, DC: Maternal and Child Health Policy Research Center, 92 pp.

Annotation: This report presents new information on states' 1996 Medicaid managed care policies affecting children and on the ways these policies are expected to change in the future. The report looks at primary care case management systems (PCCMs) and more fully on fully capitated plans and the future directions of each. An appendix summarizes the findings in a table. [Funded by the Maternal and Child Health Bureau]

Contact: Maternal and Child Health Policy Research Center, 750 17th Street, N.W., Suite 1100, Washington, DC 20006-4607, Telephone: (202) 223-1500 Fax: (202) 496-9067 $40.00, plus shipping and handling.

Keywords: Capitation rates, Children, EPSDT, Enrollment, Health care costs, Health insurance, Medicaid managed care, Public policy

U.S. General Accounting Office. 1997. Medicaid managed care: Challenge of holding plans accountable requires greater state effort. Washington, DC: U.S. General Accounting Office, 116 pp.

Annotation: This report reviews a study that looked into state efforts to ensure managed care plans are accountable for meeting Medicaid program goals and for providing beneficiaries enrolled in capitated managed care plans the care they need. A focus on the study was the difficulty in monitoring such managed care programs for compliance. The study reviewed state actions in four states—Arizona, Tennessee, Pennsylvania, and Wisconsin—and focused on 10 core accountability measures. Accompanying appendices provide the scope and methodology of the study and federal and state oversight roles of Medicaid managed care.

Contact: U.S. Government Accountability Office, 441 G Street, N.W., Washington, DC 20548, Telephone: (202) 512-3000 E-mail: [email protected] Web Site: http://www.gao.gov Available from the website. Document Number: GAO/HEHS-97-86.

Keywords: Access to health care, Accountability, Capitation rates, Enrollment, Medicaid managed care, State health insurance programs

Schwalberg R, Hill I. 1995. Coordinating adolescent health centers and managed care: State experiences and lessons learned. Washington, DC: Health Systems Research, 39 pp.

Annotation: This report discusses the challenge of integrating adolescent health services with prepaid managed care systems. Policy and design issues in Medicaid managed care, coordination with school-based health centers, and state efforts to facilitate coordination are addressed. Threats to adolescent care created by the convergence of these influences including the limitations placed on school clinics, the lack of privacy valued by adolescents, inclusion in capitation rates, and the potential duplication of funding are discussed. [Funded by the Maternal and Child Health Bureau]

Contact: Altarum Institute, 3520 Green Court, Suite 300, Ann Arbor, MI 48105, Telephone: (734) 302-4600 Secondary Telephone: (800) 879-6505 Fax: (734) 302-4991 Web Site: http://www.altarum.org/contact Available from the website.

Keywords: Adolescent health services, Capitation rates, Managed care, Medicaid, School health services

U.S. General Accounting Office. 1993. Medicaid: HealthPASS: An evaluation of a managed care program for certain Philadelphia recipients. Washington, DC: U.S. General Accounting Office, 77 pp.

Annotation: This report evaluates the HealthPASS (Philadelphia Accessible Services System) program, a managed care system for some 115,000 Medicaid recipients in south and west Philadelphia. HealthPASS uses a health maintenance organization (HMO) model to provide care. The report describes the program's financing, structure, and activities, and evaluates whether members are receiving timely and appropriate pregnancy-related services; Early and Periodic Screening, Diagnostic and Treatment (EPSDT); and services through the Special Supplemental Food Program for Women, Infants and Children (WIC). The report also examines whether the financial incentives offered to participating physicians compromise the quality of care provided, and evaluates the program's quality assurance system and credentialing process.

Contact: U.S. Government Accountability Office, 441 G Street, N.W., Washington, DC 20548, Telephone: (202) 512-3000 E-mail: [email protected] Web Site: http://www.gao.gov Available from the website. Document Number: GAO/HRD-93-67.

Keywords: Capitation rates, Health maintenance organizations, Medicaid managed care, Pennsylvania, Program evaluation, Quality assurance
   

The MCH Digital Library is one of six special collections at Geogetown University, the nation's oldest Jesuit institution of higher education. It is supported in part by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under award number U02MC31613, MCH Advanced Education Policy with an award of $700,000/year. The library is also supported through foundation and univerity funding. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.