Performance Improvement 1999. Disability, Aging, and Long-Term Care Policy

02/01/1999

TITLE: Children with Severe Chronic Conditions on Medicaid

ABSTRACT: Many children with special health care needs depend on the health and supportive services provided by Medicaid. It is important that policymakers have a sound understanding of these children's patterns of health care use, especially given the shift to managed care. Previous studies of children on Medicaid with severe disability and/or chronic illness have focused on "SSI-related" children, or children with extremely high health care costs. This study provides further analysis of Medicaid expenditures for SSI children, and adds to the literature by applying diagnostic and utilization-based criteria to claims data to identify children with severe chronic illness. This methodology enables analysis of the service use patterns and expenditures for children with severe chronic conditions who are receiving Medicaid, but are not enrolled in SSI. Three data sources were used in the analysis: (1) Medicaid administrative records extracted from the Health Care Financing Administration's (HCFA's) database provided data on Medicaid service utilization and expenditures. (2) The 1992 MarketScan database, a proprietary database of integrated claims and population data of individuals enrolled in private insurance plans, was used to compare the prevalence of children with chronic conditions and private health insurance coverage, to the prevalence of children with chronic conditions enrolled in Medicaid. (3) For SSI children, data on the principal disabling condition (as identified by the disability determination process) were obtained from Social Security Administration records. Results of the study indicate that there are many more children with severe chronic conditions receiving Medicaid coverage than simply those who become eligible for Medicaid through the SSI program.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: John Drabek, Ph.D.

PHONE NUMBER: 202-690-6613

PIC ID: 5758

PERFORMER ORGANIZATION: MEDSTAT Group Cambridge, MA
 

TITLE: Consumer-Directed Personal Assistance Services: Key Operational Issues for State CD-PAS Programs Using Intermediary Service Organizations

ABSTRACT: This study was initiated by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) to identify best practices for implementing consumer-directed personal assistance (CD-PAS) programs through the use of various intermediary service organization (ISO) models. Twenty-three State and Medicaid-funded CD-PAS programs that used ISOs in eleven States were examined. The term personal assistance services (PAS) refers to a range of human and mechanical assistance provided to persons with disabilities of any age who require help with routine activities of daily living. Consumer-directed modes of financing and delivering PAS permit the consumer (as opposed to medical or social work professionals) comparatively greater choice and control over all aspects of service provision including: (1) recruiting, hiring, and training attendants; (2) defining attendants' duties and work schedules; (3) supervising attendants regarding how specific tasks are to be performed; (4) managing the payroll functions, including paying attendants; and (5) disciplining and discharging attendants. When a third party payor is involved in financing PAS (e.g., private insurance or publicly-funded programs such as Medicaid), certain limitations may be placed on the consumer's ability to exercise choice and control over his or her PAS. Because of these issues, States have begun to develop a variety of intermediary service organization (ISO) models to facilitate the use of CD-PAS programs by persons with disabilities and chronic conditions, and to assist government policymakers in achieving an appropriate balance among competing goals. ISO models seek to provide appropriate PAS that affords consumers choice and control, while assuring program and fiscal accountability, regulatory, compliance, protection from liability, service quality and consumer health and safety. This report examines several ISO models.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6443

PIC ID: 6164

PERFORMER ORGANIZATION: Systemetrics, Inc. Washington D.C.
 

TITLE: Evaluation of the District of Columbia's Demonstration Program, "Managed Care System for Disabled and Special Needs Children"

ABSTRACT: This project evaluates the District of Columbia's managed care demonstration program for disabled and special needs children. The demonstration program relies on a Medicaid-financed managed care system for children in the District's Supplemental Security Income (SSI) program, and is offered to eligible children as an alternative to the traditional Medicaid fee-for-service system. Enhanced Medicaid benefits through the demonstration program include individual treatment plans, respite care, van transportation and taxi vouchers, care management services and limited-use phones. The Medicaid payment system includes risk sharing based on 85 percent risk corridors (as defined by medical loss ratios) between the District's Medicaid office and the non-profit health plan operating the demonstration, a capitated payment system for the health plan, and negotiated fee schedules for providers. This evaluation considers access and cost issues, placing considerable emphasis on issues related to quality of care and satisfaction. The research design centers on three main activities: (1) analyses of the implementation of the demonstration; (2) analyses of enrollment which will describe which children enroll and disenroll in this type of system; and (3) outcomes analyses that document the experiences of the District, plan, providers, children and families. The study of the implementation of the demonstration is based on interviews, a series of site visits to the District's Medicaid office and HSCSN, and review of the documentary record. This project was co-funded by the Health Care Financing Administration (HCFA).

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Gavin Kennedy

PHONE NUMBER: 202-690-6443

PIC ID: 7015

PERFORMER ORGANIZATION: Abt Associates, Inc., Cambridge, MA and Urban Institute Washington D.C.
 

TITLE: Exploratory Study of Health Care Coverage and Employment of People with Disabilities

ABSTRACT: Most policymakers agree that the current structure of the Social Security Administration's disability programs creates substantial work disincentives for people with disabilities. One set of policy options concerns changing the links both between Medicare and the Social Security Disability Insurance (DI) program, and between Medicaid and the Supplemental Security Income (SSI) program. More generally, reforms that expand access to health insurance for people with disabilities who are not DI or SSI recipients could have an impact on both employment and program participation. The purpose of this study is to examine empirical evidence on the relationships among health insurance, employment and program participation of people with disabilities. Specifically, it presents the findings of an analysis of expansions in the income threshold for the SSI work incentive program established by Section 1619 of the Social Security Act. These expansions have allowed many working SSI recipients to maintain Medicaid eligibility even after their incomes rise above the level that makes them ineligible for SSI payments. This report also presents findings from an analysis of the employment, insurance and program participation status of people with disabilities using the 1993 Survey of Income and Program Participation (SIPP) and the 1994 National Health Interview Survey (NHIS). This analysis focuses on groups of people with disabilities who would most likely be affected by expansions in public health insurance.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Kathleen Bond

PHONE NUMBER: 202-690-6443

PIC ID: 6240

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA
 

TITLE: International Evidence on Disability Trends Among the Elderly

ABSTRACT: Recent studies indicate that disability rates among the elderly may be declining. The data for these findings come from the National Long-Term Care Survey. Currently, over forty programs assist persons with disabilities. Information on trends in elderly disability rates could help in estimating the size of the population eligible for these programs, as well as their projected costs. This project attempts to: (1) assemble the evidence regarding trends in disability rates among the elderly; (2) critique the evidence from a scientific perspective; (3) carry out additional analyses and expand the evidence on trends, especially on differences of age, gender, and other subgroup status; and (4) assess the implications for disability policy and expenditure trends.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: William Marton

PHONE NUMBER: 202-690-6443

PIC ID: 6719

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.
 

TITLE: Meeting The Challenge of Serving People With Disabilities: A Resource Guide for Assessing the Performance of Managed Care Organizations

ABSTRACT: This Resource Guide is designed to support efforts to measure and improve Medicaid Managed Care Organization (MCO) performance for people with disabilities. The purpose of the guide is threefold: (1) To provide an overview of the issues to be considered in measuring the performance of MCOs; (2) To bring together in one volume, key information about measures that now exist, or are about to be made available, that can be counted on to support efforts to measure and improve the care provided by MCOs to people with disabilities; and (3) To make clearer the areas where technically strong measures do not exist, in order to encourage further measurement development in these areas. Additionally, the guide presents the results of an extensive search for existing performance measures that can be used for quality measurement and improvement by: (1) State Medicaid agencies; (2) managed care organizations; (3) providers within MCOs; and (4) people who advocate for the health care needs of the disabled.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Gavin Kennedy

PHONE NUMBER: 202-690-6443

PIC ID: 7060

PERFORMER ORGANIZATION: Center for Health Policy Research , Washington, DC
 

TITLE: Report on In-Depth Interviews with Developers

ABSTRACT: This report is intended to supplement ongoing research being conducted as part of The National Study of Assisted Living. In this supplementary study, detailed interviews were conducted with 29 individuals from 21 States who are involved in various aspects of the development of assisted living facilities (e.g., architects, builders, developers and consultants to the development industry). The report provides preliminary information concerning barriers to the development of assisted living and future trends in the industry, as well as the potential for assisted living to serve a larger lower income and Medicaid-eligible population. The study focuses on the following issues: (1) trends in the supply and demand for assisted living; (2) barriers to the development of assisted living; (3) scope and status of the regulatory and quality assurance systems for assisted living; (4) ways in which the current assisted living industry embodies the principles of consumer choice and autonomy, and the extent to which the industry matches the conceptual model of assisted living; and (5) the effects of different models of assisted living on consumer and worker satisfaction, resident length of stay, affordability, and its potential substitutability for nursing home care. The findings of the report are designed to provide a context for the larger study and provide information about emerging trends.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6443

PIC ID: 4719.5

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC
 

TITLE: State Assisted Living Policy: 1998

ABSTRACT: This study reviewed the assisted living and board-and-care policies in each of the 50 States. States reported a total of 28,131 licensed facilities with 612,063 units or beds. Over 25 percent of the beds are located in three States: California (123,238); Florida (66,293); and Pennsylvania (62,241). Twenty-two States have existing licensing regulations using the term assisted living, up from 15 in the previous study. Wisconsin has re-named their assisted living regulations as residential-care apartment complexes. Draft regulations using the term assisted living have been developed by an additional nine States, including Maryland, which is significantly expanding the scope of an earlier program, previously termed, "assisted living". Four States are revising existing assisted living regulations. West Virginia is developing rules for a new category and New Hampshire revised rules which took effect in 1998. Thirty-five States reimburse, or plan to reimburse, services in assisted living or board-and-care facilities as a Medicaid service. Eleven States had created a task force or a process within a State agency to make recommendations for developing assisted living rules. While a common or standard definition of assisted living is still unlikely, State approaches share some common components. This new model for long-term care is developing as a residential, rather than institutional, model. The major issues addressed by State policies concern requirements for the living unit, for tenant admission/retention, level of services allowed, and for administrator and staff training. This report describes the primary approaches States are taking to license assisted living, discusses Medicaid reimbursement and other selected areas, and summarizes each State's licensing rules.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6443

PIC ID: 4719.6

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC
 

TITLE: The Role of Home and Community-Based Services in Meeting the Health Care Needs of People with AIDS: Final Report

ABSTRACT: Home- and community-based services, such as assistance with daily living activities and the provision of home-delivered meals, have long been an integral part of AIDS care. However, improved health and functioning have broadened the scope of these services. Changes in AIDS treatment and in the characteristics of the AIDS population have had profound and interrelated effects on the use of home- and community-based services by people with AIDS and increased life expectancy has increased the duration of needed services. Improved treatment has also improved health and decreased levels of functional impairment for many people, which in turn appears to have led to a decrease in the use of traditional home- and community-based services (such as home-delivered meals and personal care). At the same time, this treatment has led to a greater need for other types of support, such as assistance with treatment adherence and return to work. Meanwhile, the increased incidence of AIDS among people with low incomes, people with substance abuse problems, and women with families has led to an increased need for home- and community-based service providers to interact more often with substance abuse treatment, mental health, family services and public assistance systems. The goal of this project was to assist in the development of a research agenda for studying home- and community-based service use among people with AIDS. The project had three components: (1) a review of the literature describing the delivery and financing of home- and community-based services for people with AIDS, (2) case studies of service provision in New York City and Los Angeles, and (3) an analysis of use and reimbursement patterns for New Jersey Medicaid beneficiaries with AIDS.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Gavin Kennedy

PHONE NUMBER: 202-690-6443

PIC ID: 6418

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Plainsboro, NJ