A National Study of Commercial Health Insurance and Medicaid Definitions of Medical Necessity: What Do They Mean for Children? To analyze medical necessity standards used by state Medicaid agencies and the largest commercial insurers in the United States on the basis of criteria re......
Using HMOs to serve the Medicaid population: what are the effects on utilization and does the type of HMO matter? States have increasingly used Health Maintenance Organizations (HMOs) to provide medical services to the Medicaid population. However, the effects of these... B Herring,EK Adams - ...
For Medicaid-funded personal care services, states must now require the use of EVV to avoid financial penalties. By January 1, 2023, this will include home health care services. However, for most states, full EVV compliance has just begun. In response to stakeholder feedback and the ...
Medicaid managed long-term care: is Florida ready? MAA collects HEDIS[R] results from MCOs, conducts studies with theEQRO, and sponsors a statewide survey using the CAHPS[R] and FAACT survey instruments. Evidence of Innovative Uses of Performance Measures Among Purchasers ...
Similar to PCF, DC is a set of voluntary payment models. In an effort to support multipayer alignment, the DC models are intended to offer a broader range of organizations, including accountable care organizations (ACOs), MA plans, and Medicaid managed care organizations (MCOs), an opportunity...
The Asthma Care Quality Assessment (ACQA) Project is a multipart observational study aimed at identifying factors influencing quality of care for Medicaid-insured children with asthma. Given the participating MCOs' reputations for engagement in quality improvement activities and their interest in assessing...