Effects of case management and new drugs on Medicaid AIDS spending.
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This study evaluates the effects of Florida's participation in the Medicaid acquired immunodeficiency syndrome (AIDS) home and community-based waiver and the use of recently developed AIDS drugs on spending per Medicaid beneficiary. We find that monthly Medicaid spending for waiver non-participants was significantly higher than was spending for waiver nonparticipants. The major reason for the cost difference is that nonwaiver enrollees incurred significantly higher inpatient costs than did those enrolled in the waiver. Although waiver enrollees had higher drug spending, these represent only a fraction of the higher inpatient costs incurred by nonwaiver enrollees. Thus, it appears that adherence to appropriate medications reduces the need for inpatient care. The case management approach of the AIDS waiver may have similar effects for persons with other chronic diseases. (+info)
Key components of a statewide Healthy Communities effort.
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The Healthy Cities/Healthy Communities movement is in its second decade. Examples of both successful and unsuccessful Healthy Communities efforts can be found in large and small communities across the country. What are the key components of a successful effort? Movement leaders from California, Massachusetts, Pennsylvania, and South Carolina as well as the Centers for Disease Control (CDC) and Prevention have contributed their collective experience to identifying the key components of a statewide Healthy Communities effort. Assessing the degree to which a state has these key components in place can help the state take steps to assure support for Healthy Communities. (+info)
A model memorandum of collaboration: a proposal.
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The authors propose a model memorandum of collaboration for use by state and community partnerships, support organizations, and grantmakers in working together to build healthier communities. Described as an idealized social contract, the model memorandum lays out interrelated responsibilities for the key parties. (+info)
Opportunities and challenges in Medicaid managed care: the experience in Maryland.
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OBJECTIVE: The effects of the Maryland Medicaid mandatory managed care programs on Medicaid beneficiaries are examined with the main objective of gaining insight into the initial experience and beneficiary satisfaction with Maryland's Medicaid program. The background of the Maryland Medicaid system, initial implementation, results of beneficiary satisfaction surveys, and future concerns are discussed. STUDY DESIGN: An observational study based on survey data. DATA AND METHODS: Beneficiary surveys mailed to adult and child participants in HealthChoice and the Rare and Expensive Case Management (REM) Medicaid programs in Maryland are analyzed. Descriptive univariate and bivariate data statistics are used. RESULTS: The 4 questions rating satisfaction with primary care provider (PCP), relevant specialists, all providers, and the overall health plan indicate high levels of satisfaction in both adult and child populations. CONCLUSIONS: The Maryland Medicaid programs appear to have met the goal of providing a comprehensive, coordinated healthcare system of quality care during their first year of operation. The satisfaction of these beneficiaries suggests that with an appropriate risk-adjusted capitation approach, managed care organizations (MCOs) can successfully provide for even the most complex needs of Medicaid members. (+info)
Medicare's governance and structure: a proposal.
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Medicare and Medicaid need new organizational structures. At the start of a new administration, the Health Care Financing Administration (HCFA) should be replaced by separate agencies to administer Medicare (a Federal Health Programs Administration) and Medicaid plus other state grant programs (a State Health Programs Administration). A new Medicare management agency should have different centers for beneficiary services, provider payments, health plans, prescription drugs, and program development/special populations. The future Department of Health and Human Services (HHS) should have an assistant secretary for prevention and health care quality, and a new Congress should establish a Joint Health Committee. (+info)
Preventive service use and Medicaid managed care in New York City.
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OBJECTIVE: To examine the effect of managed care enrollment on the use of preventive services among New York City's Medicaid population. STUDY DESIGN: An analysis of survey results from a sample of Medicaid beneficiaries in managed care plans and in traditional Medicaid. METHODS: This study is based on a 1994 survey of 1038 Medicaid beneficiaries enrolled in any of 5 managed care plans and a comparison group of 410 beneficiaries in traditional Medicaid in New York City. The survey data are used to examine the effect of managed care on the self-reported use of Pap smears, mammograms, and infant immunizations. We performed bivariate analysis to compare the use of preventive services between managed care enrollees and beneficiaries in traditional Medicaid. We also used multivariate logistic analysis to explore this comparison, controlling for factors that may confound the relationship. RESULTS: Medicaid beneficiaries in managed care were no more or less likely to receive infant immunizations, Pap smears, or mammograms than those in the traditional Medicaid program. CONCLUSIONS: Our analysis suggests that Medicaid managed care and the traditional program performed the same in getting appropriate preventive services to beneficiaries. (+info)
Nevada State plan; final approval determination. Occupational Safety and Health Administration (OSHA), U.S. Department of Labor. Final State plan approval--Nevada.
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This document amends OSHA's regulations to reflect the Assistant Secretary's decision granting final approval to the Nevada State plan. As a result of this affirmative determination under section 18(e) of the Occupational Safety and Health Act of 1970, Federal OSHA's standards and enforcement authority no longer apply to occupational safety and health issues covered by the Nevada plan, and authority for Federal concurrent jurisdiction is relinquished. Federal enforcement jurisdiction is retained over any private sector maritime employment, private sector employers on Indian land, and any contractors or subcontractors on any Federal establishment where the land is exclusive Federal jurisdiction. Federal jurisdiction remains in effect with respect to Federal government employers and employees. Federal OSHA will also retain authority for coverage of the United States Postal Service (USPS), including USPS employees, contract employees, and contractor-operated facilities engaged in USPS mail operations. (+info)
The Children's Health Insurance Program: expanding the framework to evaluate state goals and performance.
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A comprehensive framework was devised to evaluate the State Children's Health Insurance Program (SCHIP) established in 1997. The framework relies on a number of potential measures and data sources for reviewing the program information recorded by states in SCHIP applications, particularly their strategic objectives and proposed performance measures. The analysis reveals that the states propose a wide range of objectives and measures and that there is considerable variation among the states. Overall, states' SCHIP plans tend to stress program enrollment and access to services but fail to emphasize the type and quality of services children receive once they are enrolled in the program. A broader conceptual framework is needed for policy makers, advocates, and researchers to make a full assessment of state goals and SCHIP performance. (+info)