DEVELOPMENT OF A CAPITATION MANUAL FOR STATE MEDICAID PROGRAMS

THE PRIMARY PURPOSE OF THIS PROJECT IS TO DEVELOP A PRACTICAL MANUAL FOR THE PLANNING, DESIGN, AND IMPLEMENTATION OF MEDICAID ALTERNATIVE DELIVERY SYSTEM (ADS) PROGRAMS. STATE MEDICAID PROGRAM EXPERIENCES WITH HEALTH MAINTENANCE ORGANIZATIONS AND OTHER ADS PROGRAMS HAVEBEEN MIXED, WITH SOME STATES ACHIEVING THEIR COST, QUALITY OF CARE, AND ACCESS OBJECTIVES AND OTHERS NOT. STATES HAVE SOMETIMES UNDERESTIMATED THE COMPLEXITY OF THE DESIGN AND IMPLEMENTATION REQUIREMENTS AND OVERESTIMATED COST SAVINGS ACHIEVED UNDER THE PROGRAMS. THIS MANUAL WILL HELP STATES THAT ARE CONSIDERING ADS APPROACHES LEARN FROM THE EXPERIENCES AND MISTAKES OF OTHERS AND DEVELOP REALISTIC ADSSTRATEGIES AND EXPECTATIONS. THE PRIMARY PROJECT TASKS ARE: A REVIEW OF THE LITERATURE ONMEDICAID CAPITATION EXPERIENCES; INTERVIEWS WITH RECOGNIZED EXPERTS AND WITH THOSE INVOLVED IN MEDICAID ADS PROGRAM IMPLEMENTATION; AND PREPARATION OF A CLEAR, COMPREHENSIVE MANUAL FOR PLANNING, DESIGN, AND IMPLEMENTATION OF MEDICAID ADS INITIATIVES. DURING PHASE II, THE CENTER FOR HEALTH POLICY STUDIES WILL PROVIDE TRAINING SEMINARS FOR INDIVIDUAL STATES OR GROUPS OF STATES ON MEDICAID ADS PROGRAM IMPLEMENTATION. THESE SEMINARS WILL COVER THE ENTIRE PLANNING, DESIGN, AND IMPLEMENTATION PROCESS AS WELL AS FOCUS ON SPECIFIC CRITICALTASKS.