Content by Keyword: Case Management

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Final Outcome Evaluation of the Balancing

Final Outcome Evaluation of the Balancing Incentive Program

Sarita L. Karon, PhD, Molly Knowles, MPP, Brieanne Lyda-McDonald, MS, Nga Thach, BS, and Joshua M. Wiener, PhD RTI International Diane Justice, MA, Scott Holladay, MPA, John Tranfaglia, BA National Academy for State Health Policy Mary Sowers, BA National Association of State Directors of Developmental Disability Services Printer Frien
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Final Outcome Evaluation of the Balancing

Final Outcome Evaluation of the Balancing Incentive Program

This is the final report of the Balancing Incentive Program evaluation. Five earlier progress reports on the Balancing Incentive Program (BIP) have already been published. The BIP, legislated in the 2010 Affordable Care Act, offered states temporary enhanced federal financial participation for Medicaid home and community-based services (HCBS). Par
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Basic report
Preliminary Outcome Evaluation of the Balancing

Preliminary Outcome Evaluation of the Balancing Incentive Program

Sarita L. Karon, PhD; Molly Knowles, MPP; Brieanne Lyda-McDonald, MS; Trini Thach, BS; and Joshua M. Wiener, PhD RTI International Diane Justice, MA; Scott Holladay, MPA; and John Tranfaglia, BA National Academy for State Health Policy Mary Sowers, BA National Association of State Directors of Developmental Disability Services Printer
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Preliminary Outcome Evaluation of the Balancing

Preliminary Outcome Evaluation of the Balancing Incentive Program

This is a follow-up to four earlier evaluation reports on the Balancing Incentive Program (BIP). The BIP, legislated in the 2010 Affordable Care Act, offered states temporary enhanced federal financial participation for Medicaid home and community-based services (HCBS). Participation was limited to states that, as of 2009, were allocating less tha
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Final Process Evlauation of the Balancing

Final Process Evaluation of the Balancing Incentive Program

Sarita L. Karon, PhD, Molly Knowles, MPP, Brieanne Lyda-McDonald, MS, Trini Thach, BS, and Joshua M. Wiener, PhD RTI International Diane Justice, MA, Scott Holladay, MPA, and John Tranfaglia, BA National Academy for State Health Policy Mary Sowers, BA National Association of State Directors of Developmental Disability Services Printer
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Final Process Evlauation of the Balancing

Final Process Evaluation of the Balancing Incentive Program

This is a follow-up to three earlier evaluation reports on the Balancing Incentive Program. The Balancing Incentive Program, legislated in the 2010 Affordable Care Act (ACA), offered states temporary enhanced federal financial participation for Medicaid home and community-based services (HCBS). Participation was limited to states that, as of 2009,
From: Final Process Evaluation of the Balancing Incentive Program
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Endnote

Emerging Practices in Medicaid Primary Care Case Management Programs. Endnote

1.  In general, "TANF" refers to other poverty-related populations in addition to TANF beneficiaries. However, Alabama makes a distinction between SOBRA women and SOBRA children; SOBRA children are mandatorily enrolled, while SOBRA adults are not eligible.
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Appendix C

Emerging Practices in Medicaid Primary Care Case Management Programs. Appendix C

Case Study States' Enrollment Policies   Alabama Florida Iowa Maine North Carolina Oklahoma Texas Virginia Patient 1 st
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Appendix B: North Carolina ACCESS II & III

Emerging Practices in Medicaid Primary Care Case Management Programs. Appendix B: North Carolina Access II & III Core Elements of the Asthma Disease Management Program

Build Capacity for Routine Assessment of Asthma
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Appendix A: Case Study States' Contacts

Emerging Practices in Medicaid Primary Care Case Management Programs. Appendix A: Case Study States' Contacts

Charlene J. Benson Director, Medicaid Care Management Oklahoma Health Care Authority 4545 North Lincoln Suite 124 Oklahoma City, OK 73105 405-522-7366 bensonc@ohca.state.ok.us Scott F. Cannady Managed Care Unit Supervisor Department of Medical Assistance Services P.O. Box 537 Richmond, VA 23204 804-786-5445 SCannady@dmas.
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Appendices

Emerging Practices in Medicaid Primary Care Case Management Programs. Appendices

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Conclusions

Emerging Practices in Medicaid Primary Care Case Management Programs. Conclusions

As Medicaid managed care has evolved during the past decade, states have balanced the development of their PCCM programs with the growth and/or decline of risk-based managed care. Each state has taken a slightly different approach, depending in part on the state's particular managed care environment. Some states developed PCCM as a stepping stone
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Enrollment

Emerging Practices in Medicaid Primary Care Case Management Programs. Enrollment

State advice on enrollment focused mostly on additional roles a contracted enrollment broker can play. Use the enrollment broker to recruit providers, in order to learn the area before starting member enrollment. Use the enrollment broker for member education. Do not try to enroll a great number of people into a mandatory program all at onc
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Service Management

Emerging Practices in Medicaid Primary Care Case Management Programs. Service Management

States with active care coordination components to their PCCM programs reported that providers and beneficiaries found them very helpful. Other recommendations included Recognize that the referral process is key to managing services Make prior authorization and other state-required procedures as hassle-free as possible for providers. Employ
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Finance

Emerging Practices in Medicaid Primary Care Case Management Programs. Finance

States with incentive payment systems noted that these systems can be very effective in reinforcing the state's key program goals.
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Quality Activities

Emerging Practices in Medicaid Primary Care Case Management Programs. Quality Activities

Case-study states have implemented a broad range of mechanisms to ensure high quality care for members. Therefore, their advice covers a wide range of issues.
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Providers

Emerging Practices in Medicaid Primary Care Case Management Programs. Providers

Case study state officials agreed that provider commitment is the key to their success. Their advice stressed identifying and implementing ways to obtain the buy-in of a wide variety of providers.
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Organizational Structure

Emerging Practices in Medicaid Primary Care Case Management Programs. Organizational Structure

Advice on organizational structure emphasized the need for sufficient state investment of personnel and resources:
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Overall Advice

Emerging Practices in Medicaid Primary Care Case Management Programs. Overall Advice

The most frequent advice given by case-study states is to use the principles and tools of MCOs, such as prior authorization, performance standards, benchmarks, and quality strategies. This was asserted by the majority of case-study states. Other advice includes
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Chapter 9: Lessons Learned: State Perspectives

Emerging Practices in Medicaid Primary Care Case Management Programs. Chapter 9: Lessons Learned: State Perspectives

Those who participated in the interviews conducted for this report provided a wealth of information on how their Medicaid PCCM programs have evolved and the actions they have taken to get their programs to their present incarnations. These state officials had a myriad of advice to share with states looking to replicate the innovations they have im

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