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Many of the payment reform approaches outlined by the Center for Medicare and Medicaid Innovation (CMMI) established by The Centers for Medicare & Medicaid Services are initiatives that states have pursued for some time, such as medical homes, says Neva Kaye, managing director for health system performance at the Washington, DC-based National Academy for State Health Policy (NASHP).
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Not surprisingly, the biggest current fiscal challenge for Delaware Medicaid is the dramatic increase in enrollment over the past two years, according to Rita M. Landgraf, secretary of the state's Department of Health and Social Services.
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For Medicaid programs that have good relationships with managed care contractors already in place, it's a "natural development" to add the population of seniors and people with disabilities, says Alice R. Lind, RN, MPH, senior clinical officer at the Center for Health Care Strategies (CHCS) in Hamilton, NJ. "The timing is right now, because budgets are tight."
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In previous years, there was a widespread perception that the reason managed care was cost-effective was that services were restricted, according to Alice R. Lind, RN, MPH, senior clinical officer at the Center for Health Care Strategies (CHCS) in Hamilton, NJ. This was a largely undeserved reputation, she says, but it worked against managed care expansion.
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States have some good fiscal opportunities to expand home- and community-based services (HCBS) in the Patient Protection and Affordable Care Act (PPACA), according to Charlene Harrington, RN, PhD, FAAN, director of the University of CaliforniaSan Francisco's National Center for Personal Assistance Services.
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The problem of "churning," when individuals cycle on and off Medicaid rolls, is expected to increase after the Medicaid expansion, according to a study published in the February 2011 issue of Health Affairs, "Issues In Health Reform: How Changes In Eligibility May Move Millions Back And Forth Between Medicaid And Insurance Exchanges."
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The National Quality Forum has a time-limited (pilot) measurement of influenza vaccination coverage of healthcare personnel.
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At Virginia Mason Medical Center in Seattle, every health care worker, contractor, vendor, and volunteer needs to be tracked for the hospital's strict mandatory influenza vaccination policy.
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The California regulation, which became effective in 1991, includes the following provisions:
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Hospitals should provide pertussis vaccines to their health care workers free of charge, but should still treat employees with antibiotics if they have unprotected exposure to patients with pertussis and work with patients at high risk, such as young infants, a federal vaccine advisory panel says.
