The objective of pilot-testing was to determine the scientific acceptability of the measures based on NQF criteria. Table III.5 , summarizes the evidence found for each measure through our pilot-testing activities using our 22-state MAX dataset (2007) and our 16-state MAX dataset (2008). Cells containing an 'X' indicate that a measure met predete
The feedback from public comment was positive, with 87 percent of the comments either supporting the measures or supporting them with modifications ( Appendix D ). The majority of the comments touched on issues that had been discussed by the project team and the TAG during the measure development process, such as expanding the denominator in the p
The project team sought to develop measures in three domains, pharmacology, psychosocial care, and physical health, as well as cross-cutting measures that span several of these domains. Tables III.1-III.4 list the proposed measure concepts, the measures that were specified and tested in focus groups, the measures that were tested in the MAX data,
This report explores how several states have designed their quality monitoring and improvement programs for managed long-term services and supports (MLTSS). The authors focus on the early adopters of MLTSS as well as those programs that are presented considered "established". The findings demonstrate how states take somewhat different approaches
Cook JA, Terrell S, JonikasJA. 2004. Promoting Self-Determination for Individuals with Psychiatric Disabilities through Self-Directed Services: A Look at Federal, State and Public Systems as Sources of Cash-Outs and Other Fiscal Expansion Opportunities . Rockville, MD: Substance Abuse and Mental Health Services Administration.
One potential concern regarding SDC participants' greater independence in making decisions about their own care and in planning mental health spending is that some participants may choose not to receive mental health services, may dramatically reduce their spending on outpatient specialty mental health care services, or may not reserve enough mone
SDC models automatically place consumers of mental health services "in the driver's seat" 2 by making them the primary decision-makers in choosing services and providers and by giving them authority over an individual budget. Although this structure supports consumers' autonomy and self-direction, it also demands greater consumer involvement in
SDC programs generally do not include coverage for mental health visits to emergency departments or for mental health crisis, inpatient, or residential treatment services. These services also are not ones that participants self-direct or write into their recovery plans. Instead, these services are covered either by Medicaid, Medicare or private in
Boyd, C., B. Leff, C. Weiss, J. Wolff, A. Hamblin, and L. Martin. "Clarifying Multimorbidity Patterns to Improve Targeting and Delivery of Clinical Services for Medicaid Populations." Center for Health Care Strategies, Inc. December 2010. Available at http://www.chcs.org/publications3960/publications_show.htm?doc_id=1261201 . Accessed June 20, 20
CCNC's work relies heavily on data and information systems at the program, network, and provider levels. At the program level, CCNC uses Medicaid claims data, real-time hospital data, and other clinical information from provider EHRs, along with proprietary risk-adjustment software developed by Treo Solutions, Inc., to identify "priority patients"
Covered populations . All North Carolina Medicaid recipients with full benefits--including full dual eligible--are eligible to enroll in CCNC, with the exception of nursing home residents. As of March 2013, 1.3 million Medicaid recipients were enrolled in CCNC--over 75 percent of the state's Medicaid recipients. Therefore the demographic and othe
Individuals with serious mental illnesses (SMI) and other chronic behavioral health conditions require a comprehensive array of physical, behavioral, and other supportive services in order to live independently in the community. Recent research suggests that less than 5 percent of Medicaid beneficiaries with schizophrenia or bipolar disorder recei
Individuals with serious mental illnesses and other chronic behavioral health conditions need access to a comprehensive array of physical health, behavioral health, and other supportive services. Yet few of these individuals receive this type of care. Recent research suggests that less than 5 percent of Medicaid beneficiaries with schizophrenia or