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Regulating Managed Mental Health Care: A Policy Analysis and Discussion of the Role of Evaluation
This report analyzes recent efforts to regulate managed care practices in the provision of mental health care and discusses the relationship of these efforts to program evaluation. Regulatory measures described address areas such as information disclosure, consumer protection, mandated benefits, quality monitoring, licensing, selective contracting, and data collection. The author presents a framework of analysis that considers the concepts of "policy instruments" and "quality assurance" as they relate to regulation. Specific managed care regulatory efforts … Read More
Date: 12/1996
Author(s): David Rochefort, Ph.D.
An Overview of Evaluations of the Massachusetts Medicaid Managed Behavioral Health Care Program
This multi-authored report provides an overview of the evaluation activities conducted of the Massachusetts Medicaid managed behavioral health care program, the first statewide waiver program to deliver managed mental health and substance abuse services to Medicaid enrollees. The report includes chapters on service utilization and cost, service access and quality, provider changes, network development and maintenance, enrollment, and intersystem effects. Each of these chapters summarizes what was learned in the evaluations of the Massachusetts program … Read More
Date: 12/1996
Author(s): H. Stephen Leff, Ph.D., Virginia Mulkern, Ph.D., & Lawrence S. Woocher
Compendium of State Outcome Focused Quality Assurance Systems
The Compendium of State Outcome-Focused Quality Assurance Systems was developed in the spring of 1995 as part of a project funded by the Health Care Financing Administration (HCFA) under Contract No. 500-94-0074. The Human Services Research Institute was awarded this contract, in collaboration with the Temple University Institute on Disabilities and Jaskulski & Associates, to evaluate the Quality Assurance System for Intermediate Care Facilities for Persons with Mental Retardation (ICFs/MR). Elizabeth Couchoud served as … Read More
Date: 10/1996
Author(s): Valerie J. Bradley, Tecla Jaskulski, Celia Feinstein, Lynda Brown, Julie Silver, Barbara Raab
Capitation and Risk Management
1st Paragraph from Document: The compelling feature of managed care to entitlement-weary policy-makers and budget makers is the ability to capitate their funding obligation, shifting some or all of the risk for expenditures over and above the cap to managed care organizations. The risk may be shared by providers and consumers. There are a number of different schemes designed 1)to share the risk and 2) and to keep it at a reasonable (productive) level. … Read More
Date: 1/1996
Author(s): John Ashbaugh, Gary Smith
Consumer Managed Care Intermediaries
"Fiscal intermediaries may handle payments to the service organizations with whom consumers contract. They may also pay individuals and perform the employer-related tax functions for individuals whom consumers hire. They may perform still other functions such as screening and maintaining registries of prospective providers, training consumers and providers, and quality assurance.There isn't any direct experience, at least that we know of, with the use of intermediaries as part of consumer managed care arrangements per … Read More
Date: 1/1996
Author(s): John Ashbaugh, Gary Smith