Service Delivery

Emerging Practices in Medicaid Primary Care Case Management Programs. Use of PCCM by Population

Since 1990, states have primarily used PCCM programs to enroll people in the following Medicaid categories of eligibility: AFDC/TANF, poverty level pregnant women, and poverty level children. Medicaid use of PCCM programs for these populations has been fairly stable and very high. Also relatively stable is the use of PCCM for institutionalized pop

Emerging Practices in Medicaid Primary Care Case Management Programs. Evolution

As of 1998, 13 percent of all Medicaid beneficiaries (4.1 million people) were served through PCCM providers in 29 states. 15 Although the number of states has fallen from a high of 33 in 1994 (see Chart A), the number of beneficiaries since that time has risen (from 2.4 million in 1994). 16

Emerging Practices in Medicaid Primary Care Case Management Programs. Impact

PCCM programs have been successful in increasing the access of Medicaid beneficiaries to primary care physicians and creating medical homes, but the impact on costs is more mixed. In certain studies, access and utilization of primary care were noticeably improved, due largely to these provider-patient relationships.

Emerging Practices in Medicaid Primary Care Case Management Programs. Characteristics

In typical PCCM programs, the PCP is paid a monthly case management fee for each enrolled Medicaid beneficiary, in addition to fee-for-service reimbursement for all non-emergency primary care services that he/she provides. In return, the PCP is responsible for providing primary care and for prior authorizations to hospitals and specialty care prov

Emerging Practices in Medicaid Primary Care Case Management Programs. Intent

States began enrolling beneficiaries in their PCCM programs by the mid-1980s. In 1986, seven states had implemented PCCM programs, 4 and by 1990, 19 states had such programs. 5 Several factors motivated decisions to implement PCCM programs.

Emerging Practices in Medicaid Primary Care Case Management Programs. First Wave

The Omnibus Budget Reconciliation Act (OBRA) of 1981 allowed state Medicaid programs to implement both PCCM and risk-based managed care programs, pending HCFA(now known as CMS) waiver approval. HCFA(now known as CMS) approval required that the state satisfy two requirements.

Emerging Practices in Medicaid Primary Care Case Management Programs. Chapter 2: Background: Evolution of PCCM

Emerging Practices in Medicaid Primary Care Case Management Programs. Endnotes

1. HCFA(now known as CMS), letter from Sally K. Richardson, Director, Center for Medicaid and State Operations, PCCM Services Without Waiver , Jan. 21, 1998. 2. Neva Kaye, Cynthia Pernice, Helen Pelletier (Editor), Medicaid Managed Care: A Guide for

Emerging Practices in Medicaid Primary Care Case Management Programs. Studied States

The eight states studied (Alabama, Florida, Iowa, Maine, North Carolina, Oklahoma, Texas, and Virginia) were chosen for the range of strategies used in their PCCM programs. These programs vary in age (from one to ten years) and size (from several pilot sites to statewide). What also varies is the place of PCCM within the Medicaid managed care pict

Emerging Practices in Medicaid Primary Care Case Management Programs. Chapter 1: Introduction

Primary care case management (PCCM) is a system of managed care used by state Medicaid agencies in which a primary care provider (PCP) is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment.

Emerging Practices in Medicaid Primary Care Case Management Programs. Executive Summary

Primary care case management (PCCM) is a system of managed care used by state Medicaid agencies in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment. States began enrollin

Emerging Practices in Medicaid Primary Care Case Management Programs. Acknowledgments

This document could not have been produced without the support of the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (HHS/ASPE). Special thanks go to Jennifer Tolbert for her direction and encouragement. Thanks also go to the many state officials who participated in interviews and revi

Emerging Practices in Medicaid Primary Care Case Management Programs

June 2001 Joanne Rawlings-Sekunda, Deborah Curtis, and Neva Kaye National Academy for State Health Policy Produced for the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE)

report.pdf
PDF

Community Health Workers: Roles and Opportunities in Health Care Delivery System Reform

Community Health Workers (CHWs) are an emerging group of health professionals that have recently drawn increased national attention because of their potential to deliver cost-effective, high quality, and culturally competent health services within team-based care models. The apparent benefits of integrating CHWs into health care teams seem to depe

CHWPolicy.pdf
PDF

A Guide to Memorandum of Understanding Negotiation and Development

U.S. Department of Health and Human Services A Guide to Memorandum of Understanding Negotiation and Development Mary L. Johnson, M.S.W., and Linda M. Sterthous, M.P.A. Temple University, Institute on Aging, Mid-Atlantic Long Term Care Gerontology Center 1982 PDF Version: http://aspe.hhs.gov/daltcp/reports/1982/mouguide.pd

mouguide.pdf
PDF

The 1996 National Survey of Homeless Assistance Providers and Clients: A Comparison of Faith-Based and Secular Non-Profit Programs. Conclusions

Faith-based and other community-based non-profit organizations have a long history of helping people in need. The NSHAPC data analyzed here provide yet more evidence of the continuing importance of faith-based organizations in serving people who are homeless or on the brink of homelessness. Faith-based non-profits run the majority of homeless

Government Funding of Homeless Assistance Programs

The 1996 National Survey of Homeless Assistance Providers and Clients: A Comparison of Faith-Based and Secular Non-Profit Programs. Government Funding of Homeless Assistance Programs

Revenue streams in non-profit organizations are “a complex mix of private and public dollars raised through grants, contracts, fees for services, sales, donations, investment income, special events income, and income from commercial ventures” (Boris 1998) and NSHAPC collected only very limited funding information from service providers. The

The 1996 National Survey of Homeless Assistance Providers and Clients: A Comparison of Faith-Based and Secular Non-Profit Programs. Referrals to and from Programs

The CATI survey asked respondents where most of their clients came from — referrals from other programs, self-referral, outreach by program staff, or other. 21 Respondents were also allowed to report that there was no single source from which most of their clients came. Responses to this question are reported in Table 9 for faith-base

Primary Client Needs, Availability of Services,

The 1996 National Survey of Homeless Assistance Providers and Clients: A Comparison of Faith-Based and Secular Non-Profit Programs. Primary Client Needs, Availability of Services, and Location of Services

The above analysis provides a broad sketch of homeless client needs for a wide range of services. The remainder of this section examines a few of these needs in more detail, namely the twelve service needs that have been identified by over half of all program administrators as being needed by all or most clients (see Table 8 ). In addition t

The 1996 National Survey of Homeless Assistance Providers and Clients: A Comparison of Faith-Based and Secular Non-Profit Programs. All Client Needs

When asked about each of the 59 different service needs, administrators were asked if “all,” “most,” “some,” or “none” of their clients had this need. Table 7 lists all 59 service needs and reports what share of programs run by faith-based non-profits, secular non-profits, and government organizations have an administrator who th

Content by Keyword: Service Delivery