Emerging Practices in Medicaid Primary Care Case Management Programs. Endnotes


3. Deborah A. Freund, Medicaid Reform: Four Studies of Case Management (Washington, DC: American Enterprise Institute, 1984).

4. Maren D. Anderson, Peter D. Fox, "Lessons Learned from Medicaid Managed Care Approaches," Health Affairs 6, no. 1 (Spring 1987): 71-88.

5. See Note 2.

6. Originally, prior authorizations were typically required for emergency room use as well, but this practice is now prohibited by the BBA (see below).

7. Neva Kaye, "PCCM Contracting and Quality Monitoring", Medicaid Managed Care: A Guide for States (Second Edition) (Portland, ME: National Academy for State Health Policy, 1995), 115-135.

8. T.C. Rosenthal et al., "Medicaid Primary Care Services in New York State: Partial Capitation vs. Full Capitation," Journal of Family Practice 42, no. 4 (April 1996): 362-368.

9. A. Muller, J.A. Baker, "Evaluation of the Arkansas Medicaid Primary Care Physician Management Program," Health Care Financing Review 17, no. 4 (Summer 1996): 117-133.

10. J.A. Schoenmann, W. N. Evans, C. L. Schur, "Primary Care Case Management for Medicaid Recipients: Evaluation of the Maryland Access to Care Program," Inquiry 34, no. 2 (Summer 1997): 155-170.

11. A. Gadomski, P. Jenkins, M. Nichols, "Impact of a Medicaid Primary Care Provider and Preventive Care on Pediatric Hospitalization," Pediatrics 101, no. 3 (March 1998): E1.

12. Robert E. Hurley, J.E. Paul, Deborah A. Freund, "Going into Gatekeeping: an Empirical Assessment," Quality Review Bulletin 15, no. 10 (Oct. 1989): 306-314.

13. Stephen H. Long, Russell F. Settle, "An Evaluation of Utah's Primary Care Case Management Program for Medicaid Recipients," Medical Care 26, no. 11 (Nov. 1988): 1021-1032.

14. See Note 13.

15. See Note 2.

16. See Note 2.

17. See Note 2.

18. Complete information about the BBA and Medicaid managed care, including the actual text and a series of letter to states from HCFA(now known as CMS) regarding the BBA, is available at http://www.hcfa.gov/medicaid/bbahmpg.htm.

19. According to the letter from Timothy Westmoreland (Director, HCFA(now known as CMS) Center for State and Medicaid Operations) dated April 18, 2000, an emergency medical condition is "a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part."

20. M. Gold, et al., Medicare Managed Care: Preliminary Analysis of Trends in Benefits and Premiums, 1997-1999. (Washington, DC: Mathematica Policy Research Inc., 1999).

21. Susan Felt-Lisk, The Changing Medicaid Managed Care Market: Trends in Commercial Plans' Participation. (Washington, DC: Mathematica Policy Research Inc., 1999).

22. Charles Milligan, "States Building Second-Generation Primary Care Case Management Programs in Medicaid Managed Care, Competing Against HMOs," News and Strategies for Managed Medicare and Medicaid 6, no. 8 (Feb. 28, 2000): 6-7.

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