Guide to State Medicaid Managed Care Laws and Rules

Guide to State Medicaid Managed Care Laws and Rules

Author: Jane M. Anderson

Publisher: Jones & Bartlett Learning

Published: 1999

Total Pages: 98

ISBN-13: 9780834216068

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Guide to State Medicaid Managed Care Laws and Rules: 1999 Edition reveals the current legislative and regulatory climate regarding Medicaid in every state, including federal waivers applied for and granted. It's the most complete and current information available on how you can maintain or increase your number of covered lives. In one easy-to-use guide you get specific details of each state's Medicaid laws and rules, including: * choice of physician, * provider reimbursement, * benefits packages, * quality assurance, * utilization management, and * names of contacts at state agencies, Best of all, you'll get the details on contracting with each state, as specified by the state Medicaid office itself. You'll also get hard-to-find answers to critical questions such as: * Which states allow Medicaid patients to choose their own physicians? * How do Medicaid provider reimbursement to choose their own physicians? * What are the rules on provider network development in states where you want to do business? Get the answer to these questions and many more in Guide to State Medicaid Managed Care Laws and Rules: 1999 Edition.


Improving the Medicare Market

Improving the Medicare Market

Author: Institute of Medicine

Publisher: National Academies Press

Published: 1996-11-01

Total Pages: 384

ISBN-13: 0309175364

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Medicare beneficiaries are rapidly moving into managed care, as attempts to restrain the growth of this costly entitlement program progress. However, advocates for patients question whether the necessary information and structures are in place to enable Medicare consumers to select wisely among private-sector managed care options. Improving the Medicare Market examines how to give Medicare beneficiaries the same choice of health plan options enjoyed in the private sectorâ€"yet protect them as consumers and patients. This book recommends approaches to ensuring accountability and informed purchasing for Medicare beneficiaries in an environment of broader choice and managed careâ€"how the government should evaluate and approve plans, what role the traditional Medicare program should play, how to help to elderly understand their options, and many other practical matters. The committee discusses the information requirements of Medicare beneficiaries and explores in detail how best to respond to their special needs. And it examines the procedures that should be developed to provide the necessary protections for the elderly in a managed care system.


Managed Care Programs

Managed Care Programs

Author: Momoka Ito

Publisher:

Published: 2008

Total Pages: 0

ISBN-13: 9781604564891

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A physician usually manages a healthcare organisation and is responsible for a patient's primary needs especially medical care such as physical therapy or surgery. This book provides information concerning patients' well-beings as well as the effects of health care costs and how they reflect on the quality of care of healthcare facilities.


Managing Managed Care

Managing Managed Care

Author: Institute of Medicine

Publisher: National Academies Press

Published: 1997-04-21

Total Pages: 394

ISBN-13: 0309175054

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Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.


Health Insurance and Managed Care

Health Insurance and Managed Care

Author: Peter R. Kongstvedt

Publisher: Jones & Bartlett Learning

Published: 2019-02-14

Total Pages: 355

ISBN-13: 128415209X

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Health Insurance and Managed Care: What They Are and How They Work is a concise introduction to the workings of health insurance and managed care within the American health care system. Written in clear and accessible language, this text offers an historical overview of managed care before walking the reader through the organizational structures, concepts, and practices of the health insurance and managed care industry. The Fifth Edition is a thorough update that addresses the current status of The Patient Protection and Affordable Care Act (ACA), including political pressures that have been partially successful in implementing changes. This new edition also explores the changes in provider payment models and medical management methodologies that can affect managed care plans and health insurer.


Section 1557 of the Affordable Care Act

Section 1557 of the Affordable Care Act

Author: American Dental Association

Publisher: American Dental Association

Published: 2017-05-24

Total Pages: 60

ISBN-13: 1941807712

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Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). This brief guide explains Section 1557 in more detail and what your practice needs to do to meet the requirements of this federal law. Includes sample notices of nondiscrimination, as well as taglines translated for the top 15 languages by state.