Search Results: MCHLine

Annotation: This report examines non-emergency medical transportation (NEMT) in Medicare and Medicaid. Topics include key features of NEMT services and how these services are delivered, federal oversight, and challenges in providing NEMT and steps that state Medicaid agencies have taken to address them. Recommendations are included.

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

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Keywords: Barriers, Contract services, Coordination, Costs, Medicaid, Model programs, Policy development, State agencies, Transportation of patients

Annotation: This fact sheet for Title V programs, clinicians, and family leaders provides information about the potential effect of Medicaid and Children's Health Insurance Program (CHIP) managed care on children and youth with special health care needs (CYSHCN) and their families. Topics include requirements for managed care organizations in CHIP and opportunities to mitigate potential unintended negative consequences of Medicaid managed care for CYSHCN and their families. Promising practices and strategies from states are included. [Funded by the Maternal and Child Health Bureau]

Contact: National Resource Center for Patient/Family-Centered Medical Home, American Academy of Pediatrics, 345 Park Boulevard, Itasca, IL 60143, Telephone: (847) 434-7605 Secondary Telephone: (800) 433-9016, ext. 7605 Web Site: https://www.aap.org/en/practice-management/medical-home Available from the website.

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Keywords: Children, Contract services, Enrollment, Family centered care, Health care delivery, Health care reform, Medicaid managed care, Medical home, Model programs, Primary care, Service delivery systems, Special health care needs, State MCH programs, Youth

Annotation: This toolkit for state dental associations and Medicaid programs focuses on key diagnostic elements to consider when developing a dental program contract. Topics include ensuring an adequate network, enrollment and credentialing, securing the dentist-patient relationship, continuity of care, fee schedule and reimbursement, claims processing and appeals, the role of peers in resolving issues, monitoring education and outreach, coordination of care, contractor administrative performance monitoring, use and quality of care for enrolled populations, use management, member and provider manuals, and medical necessity and processing policies.

Contact: American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611-2678, Telephone: (312) 440-2500 Fax: (312) 440-7494 E-mail: [email protected] Web Site: http://www.ada.org Available from the website.

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Keywords: Contract services, Diagnostic techniques, Fiscal management, Legal responsibility, Medicaid managed care, Model programs, Oral health, Policy development, Program coordination, Program development, Program improvement, Quality assurance, Reimbursement, State programs, Utilization review

Annotation: This document provides guidance to Medicaid-contracted dental benefit plan managers on submitting encounters (records of procedures and services provided to Medicaid recipients enrolled in the plan) to the Louisiana Department of Health and Hospitals. Topics include responsibilities, transaction instructions, denial edit codes and descriptions, electronic data interchange certification and testing, data management of file and encounter submissions, continuous quality improvement, data assessment, adjustment process, and Medicaid administrative retroactive enrollment correction process.

Contact: Louisiana Department of Health, 628 North Fourth Street, P.O. Box 629, Baton Rouge, LA 70821-0629, Telephone: (225) 342-9500 Fax: (225) 342-5568 Web Site: http://www.dhh.louisiana.gov Available from the website.

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Keywords: Contract services, Dental care, Dental insurance, Fiscal management, Louisiana, Low income groups, Medicaid, Oral health, Provider networks, Quality assurance, Service delivery systems, State programs

Annotation: This report describes approaches in three states (California, Michigan, and Minnesota) to identify and assess children and youth with special health care needs (CYSHCN) in Medicaid managed care. Topics include identification and assessment of contract requirements; monitoring and quality improvement; and collaboration between Medicaid, health plans, Title V, and families. The report concludes with a discussion and promising practices for implementing Medicaid managed care for CYSHCN that emerged from the states studied.

Contact: National Academy for State Health Policy, 10 Free Street, Second Floor, Portland, ME 04101, Telephone: (207) 874-6524 Secondary Telephone: (202) 903-0101 Fax: (207) 874-6527 E-mail: [email protected] Web Site: http://www.nashp.org Available from the website.

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Keywords: Adolescents, Children, Collaboration, Contract services, Families, Medicaid managed care, Monitoring, Program improvement, Quality assurance, Special health care needs, Title V programs

Annotation: This brief presents contract-based options for improving access to oral health care for children and adolescents enrolled in Medicaid. It describes how states with managed-care-delivery systems can use contracting mechanisms and incentives to engage plans and health professionals in improving access to children's oral health care oral health outcomes.

Contact: Center for Health Care Strategies, 200 American Metro Boulevard, Suite 119, Hamilton, NJ 08619, Telephone: (609) 528-8400 Fax: (609) 586-3679 Web Site: http://www.chcs.org Available from the website.

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Keywords: Access to care, Children, Contract services, Medicaid managed care, Oral health, Program improvement, Service delivery systems, State programs

Annotation: This brief describes a partnership between a school district and a children's hospital to increase compliance with state law requiring all students in kindergarten and first grade entering public school for the first time to receive an oral health assessment. Contents include information about the district's contract with the hospital to provide the health team for its 10 elementary schools and preschool program, the standardized format and forms for data collection and reporting, and coordination and implementation of the oral-health-assessment plan (screening by volunteers and referral to the school nurse for follow-up care). Topics include the percentage of children identified with urgent, possible, and no oral concerns by school and compliance rates for select schools and the district as a whole.

Contact: Rady Children's Hospital-San Diego, 3020 Children's Way, San Diego, CA 92123, Telephone: (858) 576-1700 Web Site: https://www.rchsd.org/ Available from the website.

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Keywords: California, Contract services, Dental caries, Elementary schools, Legal responsibility, Legislation, Local initiatives, Model programs, Nurses, Oral health, Pediatric hospitals, Referrals, Risk assessment, School age children, School districts, School health services, Screening, Statistical data

Annotation: This report summarizes workshops delivered to five states by the authors and representatives from the Health Resources and Services Administration (HRSA) and Maternal and Child Health Bureau (MCHB) with the aim of assisting implementation of purchasing specifications for children with special health care needs and Medicaid pediatric purchasing specifications by suggesting contract language options for states to use in drafting managed care agreements. Six appendices contain materials from workshops convened in Wisconsin, Ohio, Kansas, Connecticut, and two Pennsylvania sessions.

Contact: U.S. Maternal and Child Health Bureau, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD 20857, Telephone: (301) 443-2170 Web Site: https://mchb.hrsa.gov Available from the website.

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Keywords: Access to health care, Case studies, Connecticut, Contract services, Health care costs, Kansas, Low income groups, Medicaid managed care, Ohio, Pennsylvania, State Children', Wisconsin, s Health Insurance Program

Annotation: This paper explores the issue of coordination between privatized child welfare initiatives and Medicaid managed care systems for the delivery of behavioral health care services for children and families in the child welfare system. The paper, which includes an executive summary, also contains the following sections: (1) research methods, (2) analysis of contract language, (3) summaries of site visits, (4) common themes, and (5) implications for policy and practice. An appendix contains excerpts of contractual language pertaining to coordination of behavioral health care services.

Contact: Center for Health Care Strategies, 200 American Metro Boulevard, Suite 119, Hamilton, NJ 08619, Telephone: (609) 528-8400 Fax: (609) 586-3679 Web Site: http://www.chcs.org Available from the website.

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Keywords: Health services, Behavior disorders, Child behavior, Child welfare, Contract services, Families, Initiatives, Low income groups, Medicaid, Public policy, Service coordination, Welfare

Annotation: This policy brief explores how separate State Children's Health Insurance Programs (SCHIP) structure freestanding managed care contracts, i.e., contracts that exist independently of a state's Medicaid managed care agreements, including their general terms of coverage, access, and care coordination. Charts provide data about program characteristics in each state.

Contact: George Washington University, Center for Health Policy Research, 2021 K Street, N.W., Suite 800, Washington, DC 20006, Telephone: (202) 994-4100 Fax: (202) 994-4040 E-mail: [email protected] Web Site: http://publichealth.gwu.edu/projects/center-health-policy-research Available from the website.

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Keywords: Access to health care, Contract services, Health care financing, Managed care, State children', s health insurance program

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.

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

Annotation: This report is the fourth in a series analyzing state Medicaid managed care trends. It characterizes the extent to which the 34 states that mandatorily enrolled some children in the five Balanced Budget Act (BBA) of 1997 special-needs groups in managed care organizations at the end of 1999 had in place contract requirements consistent with the interim review criteria set out in June of 1999. The report is divided into six sections: (1) background on states' mandatory enrollment of the five BBA groups of children with special needs; (2) an examination of state policies with respect to defining and identifying children with special needs; (3) contract requirements concerning treatment plans, case management, and coordination; (4) contract requirements concerning provider network capacity and access; (5) an assessment of state policies governing quality assurance and payment protections: and (6) conclusions. The appendices include six tables of statistics. [Funded by the Maternal and Child Health Bureau]

Keywords: Access to health care, Children with special health care needs, Contract services, Medicaid managed care, State health insurance programs, Statistics

Annotation: This report is devoted to the subject of pediatric managed care and Medicaid managed care. It begins with a brief explanation of the methodology and then turns to key findings and trends in purchasing pediatric services through Medicaid managed care. Benefits and coverage, including a full discussion of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, are addressed followed by related findings on additional key issues in Medicaid managed care.

Contact: George Washington University, Center for Health Policy Research, 2021 K Street, N.W., Suite 800, Washington, DC 20006, Telephone: (202) 994-4100 Contact Phone: (202) 296-6922 Fax: (202) 994-4040 E-mail: [email protected] Web Site: http://publichealth.gwu.edu/projects/center-health-policy-research Price unknown.

Keywords: Child health services, Contract services, EPSDT, Medicaid managed care, Pediatric care

Annotation: This two volume report presents the results of a study that examined 54 Medicaid managed care contracts, including 12 contracts designed exclusively for behavioral health (i.e., mental illness or addiction-related disorders) needs, and requests for proposals that states were using as of the beginning of 1997. The contracts cover comprehensive managed care services arrangements involving both inpatient and outpatient care. The contents of two types of contracts (i.e., general and behavioral health services) are analyzed. Part 1 of volume 1 discusses the implications for Medicaid managed care contracting of the Balanced Budget Act of 1997. Part 2 presents detailed findings for each major issue category addressed in the study with major conclusions which can be drawn from the specific findings and their implications. Volume 2 discusses managed care enrollment; coverage and benefits; service duties; public health and social service agency relationships; quality assurance, data, and reporting; and general qualifications and requirements.

Contact: George Washington University, Center for Health Policy Research, 2021 K Street, N.W., Suite 800, Washington, DC 20006, Telephone: (202) 994-4100 Contact Phone: (202) 296-6922 Fax: (202) 994-4040 E-mail: [email protected] Web Site: http://publichealth.gwu.edu/projects/center-health-policy-research v. 1, $30.00; v.2, $200.00; prepayment required. Limited copies of 1st ed. available. Call for information.

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Keywords: Budgets, Contract services, Enrollment, Federal legislation, Health care reform, Medicaid managed care, Mental health services, Quality assurance, State initiatives

Annotation: This report examines core issues purchasers should consider in developing state Medicaid managed care contracts. These issues are outreach, enrollment, and information; sound financial structures; standards and guidelines; quality assurance; collecting and reporting data; monitoring and evaluation; assuring appropriate provider networks and accessible settings; assuring access to needed services through service planning and care coordination; and linking resources. [Funded by the Maternal and Child Health Bureau]

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Keywords: Access to health care, Contract services, Data collection, Enrollment, Evaluation, Guidelines, Health maintenance organizations, Medicaid managed care, Monitoring, Outreach, Provider networks, Quality assurance, Reports, Standards, State health insurance programs

Annotation: This issue of "The Future of Children" focuses on the impact of managed health care arrangements for children. The topics discussed are managed care's effect on access to care and utilization of services, the quality of children's health services, the impact of state regulation of managed care, Medicaid managed care, improving state Medicaid contracts and plan practices for children with special needs, the impact of managed care on mental health services for children and their families, and defining the challenge and opportunities for children in managed health care. Also addressed in this issue are the topics of missing children and the State Children's Health Insurance Program.

Contact: David and Lucile Packard Foundation, 343 Second Street, Los Altos, CA 94022, Telephone: (650) 948-7658 E-mail: https://www.packard.org/contact-us Web Site: https://www.packard.org Available from the website.

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Keywords: Access to health care, Child health services, Child welfare, Children, Children with special health care needs, Contract services, Managed care, Medicaid managed care, Mental health services, Missing children, Public policy, Quality assurance, State Children', State MCH programs, s Health Insurance Program

Contact: Center for Women Policy Studies, 1776 Massachusetts Ave., N.W., Suite 450, Washington, DC 20036, Telephone: (202) 872-1770 Fax: (202) 296-8962 E-mail: [email protected] Web Site: http://www.centerwomenpolicy.org Available from the website.

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Keywords: Comparative analysis, Consumer protection, Contract services, Managed care, Medicaid managed care, State programs, Women', s health

Annotation: This two volume report presents the results of a study that examined the Medicaid managed care contracts of 37 states to assess the structure and content of those contracts and to extrapolate the key issues affecting Medicaid managed care. Volume 1 presents the findings of the study and makes recommendations for future policies. It focuses on these topics: the transformation of Medicaid to Medicaid managed care, the shift from the government as insurer to managed care purchaser, and the legal issues involved. It also considers issues related to the definition of the managed care service system, the process of developing contract language to achieve the administrative requirements, the relationship of Medicaid managed care with the overall health care system including public health, and the adoption of certain business concepts and the creation of the business relationships necessary to deliver services. Volume 2 of this report contains the detailed analyses of each state contract.

Contact: George Washington University, Center for Health Policy Research, 2021 K Street, N.W., Suite 800, Washington, DC 20006, Telephone: (202) 994-4100 Contact Phone: (202) 296-6922 Fax: (202) 994-4040 E-mail: [email protected] Web Site: http://publichealth.gwu.edu/projects/center-health-policy-research $25.00, v. 1; $100.00, v. 2; includes shipping and handling; prepayment required; make checks payable to Center for Health Policy Research/GWU.

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Keywords: Contract services, Decentralization, Government role, Health care reform, Health care systems, Legal issues, Medicaid managed care, Policy development, Public policy, State initiatives, Trends

Annotation: This report presents lessons learned from Healthy Start grantees as they planned and implemented the Healthy Start Initiative, a five-year demonstration program that uses a community-driven, systems development approach to reduce infant mortality and improve the health and well-being of women, infants, children, and families. This volume discusses the basics of health maintenance organizations, state Medicaid managed care programs, and how Healthy Start programs can work with both programs. It gives information on preparing to act as a contractor, deciding what services to offer, developing and marketing a managed care proposal, and proposing and negotiating a contract. [Funded by the Maternal and Child Health Bureau]

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Keywords: Contract services, Health maintenance organizations, Health promotion, Healthy Start, Infant health services, Infant mortality, Maternal health services, Medicaid managed care, Outreach, Perinatal care

Annotation: This book examines the benefits and impact of libraries outsourcing technical services though a series of case studies of outsourcing programs at select academic, public, and special libraries. It explains and evaluates the options, outcomes, and assessments in contracting out a broad range of services. Topics covered include: 1) authority control, 2) book selection, 3) collection replacement, 4) database maintenance, 5) document delivery services, 6) foreign language cataloging, 7) HTML programming, and 8) original cataloging. An annotated select bibliography is provided at the end of the book.

Contact: American Library Association, 50 East Huron, Chicago, IL 60611, Telephone: (800) 545-2433 Secondary Telephone: (888) 814-7692 Contact Phone: (800) 545-2433 ext. 5036 Fax: (312) 944-3897 E-mail: [email protected] Web Site: http://www.ala.org Available in libraries. Document Number: ISBN 0-8389-0703-2.

Keywords: Case studies, Contract services, Libraries, Management, Public libraries, Special libraries