Managed Care & Persons with Disabilities & Chronic Illnesses

State Issues & Activities

With Respect to Managed Care, Children with Special Health Care Needs, & Persons with Substance Abuse or Mental Health Problems

This session highlighted the important issues that States face in designing and implementing managed care initiatives for two important populations:

1. Children with special health needs (CSHN).
2. Persons with behavioral health problems.

In discussing the issues associated with initiatives covering children with special health needs, Mr. Hill described key challenges and promising State strategies in the following areas:

• Defining and identifying CSHN.
• Designing comprehensive benefit packages.
• Assembling a provider network with appropriate capacity.
• Integrating managed care with community-based support systems.
• Developing appropriate reimbursement arrangements.
• Designing effective quality monitoring and assurance systems.

Dr. Moss' presentation on the issues associated with developing effective managed care arrangements for persons with behavioral health problems focused on the following key issues and design questions:

• Where mental and addictive disorders fall in the context of the definition of a disability.
• Whether States should contract jointly or separately for mental health and substance abuse services.
• Whether States should carve in or carve out these services from other acute care services.
• Benefit package design decisions.
• Risk management strategies.
• Recent developments that can help States develop strong contracts with managed care plans.

References

Schwalberg R, Gabor V, Hill I, Perrin JM. Managed Care and Children with Special Health Care Needs: Strategies for Monitoring the Quality of Care. Health Systems Research, Inc., March 1997.

Stein R, Westbrook LE, Bauman LJ. The Questionnaire for Identifying Children with Chronic Conditions: A Measure Based on a Noncategorical Approach. Pediatrics 99(4):513-21.

Stein Ruth EK, Bauman LJ, Westbrook LE, et al. "Framework for Identifying Children Who Have Chronic Conditions: The Case for a New Definition. Journal of Pediatrics 122(3):342-7.

Newacheck PW, Taylor WR. "Childhood Chronic Illness: Prevalence, Severity, and Impact. American Journal of Public Health 82:364-71.

Muldoon JH, Neff JM, Gay JC. Profiling the Health Service Needs of Populations Using Diagnosis-Based Classification Systems. Journal of Ambulatory Care Management 20:1-18.

New England SERVE. Assessing the Quality of Managed Care for Children with Special Health Care Needs. Summary of a Regional Survey of Families, Primary Care Providers & Managed Care Organizations in New England. Boston, Massachusetts.

The Judge David L. Bazelon Center for Mental Health Law. Managing Managed Care for Publicly Financed Mental Health Services. Executive Summary. Washington: November 1995.

Rosenbaum S, et al. Negotiating the New Health System: A Nationwide Study of Medicaid Managed Care Contracts. Center for Health Policy Research. The George Washington University Medical Center, 1997.

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