- ACA Implementation & State Health Reform
- Coverage and Access
- Federal/State Issues
- Medicaid and CHIP
- Population and Public Health
- Providers and Services
- Acute Care
- Assisted Living
- Behavioral Health
- Case Management
- Child Development Services
- Chronic Care Management
- Community Health Centers
- Developmental Screening
- Early Childhood Services
- Emergency Care
- EPSDT
- Family Planning
- Federally Qualified Health Centers
- Home & Community Based Services
- Hospitals
- Long Term Services & Supports
- Medical Homes & Health Homes
- Mental Health
- Nursing Homes
- Oral Health
- Preventive Care
- Primary Care
- Safety Net Providers
- Quality, Cost, and Health System Performance
- ACOs
- Adverse Event Reporting
- Care Transitions
- Comparative Effectiveness
- Cost Sharing
- Delivery System Reform
- Fraud and Abuse
- Health Care Workforce
- Health Information Technology
- Managed Care
- Medical Homes & Health Homes
- Medical Malpractice
- Patient Safety
- Payment Reform
- Performance Measurement
- Provider Payment Policy
- Quality Oversight
- Specific Populations
- Adolescents
- Childless Adults
- Children
- Children with Special Health Care Needs
- Dual Eligibles
- Elders
- Families
- Low Income People
- Parents
- People with Chronic Conditions
- People with Developmental Disabilities
- Transitional Youth
- Vulnerable Populations
- Young Adults
- Youth
- Youth in Foster Care System
- Youth in Juvenile Justice System
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State Innovations to Transform and Link Small Practices
Federal and state governments play a significant role in strengthening the delivery of primary care, however current efforts have disproportionally been focused on large or multi-specialty practices. This report examines the roles states are playing to reorganize the delivery of primary and chronic care to produce more efficient and effective care, particularly in small practices. Through short case studies developed via interviews with state officials and physicians the authors highlight several state-based initiatives that seek to create high performing health systems by targeting local and regional strengths. Additionally, authors identified five themes critical to enacting strategic delivery system reforms.
December 2010» -
Implementing the Affordable Care Act: New Options for Medicaid Home and Community Based Services
States have significant roles in implementing practically all aspects of the Affordable Care Act. The Act gives states additional options for financing Medicaid home and community based services and supports (HCBS) through a combination of enhanced Medicaid matching payments, demonstrations, and new Medicaid state plan options. They include the State Balancing Incentive Payments Program, the Money Follows the Person Rebalancing Demonstration, State Plan HCBS, and Community First Choice Option. This issue brief analyzes the scenarios under which states might adopt them. In making those determinations, states will assess whether the new options improve upon the Medicaid authorities they currently use to finance HCBS, namely Medicaid 1915(c) HCBS waivers and state plan personal assistance.
October 2010» -
Long Term Services and Supports and Chronic Care Coordination: Policy Advances Enacted by the Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act enacts a variety of initiatives aimed at enhancing long term services and supports (LTSS) and coordination of primary and chronic care for older persons and adults with disabilities. Many of these establish delivery systems demonstrations and Medicaid options that states could adopt to implement state reforms. This NASHP report, supported by THE SCAN Foundation, analyzes the Act’s provisions addressing: 1) National voluntary long term care insurance; 2) Medicaid options and incentives for financing LTSS expansions; 3) Other LTSS provisions; 4) Primary and chronic care coordination; and 5) Nursing home reforms.April 2010» -
The Study Group on Long Term Care Options in Maine
The Study Group on Long Term Care Options in Maine is a group of interested citizens brought together by the National Academy for State Health Policy at the request of the UNUM Foundation to discuss how Maine provides long term care services to people in need. Because all of us could need long term care if we experience an accident, chronic illness, unexpected birth outcome, or the frailties that can come with age, it is important that citizens learn about, discuss and guide how the current system of care will serve them. We are not experts on long term care but individuals without a specific agenda or organizational viewpoint to advance. We were invited to participate in the Study Group because of our knowledge of Maine and out ability to think creatively about complex issues. We are from all over the state from Portland to Presque Isle. We see ourselves as potential consumers of long term care, and so bring the voice of the community to some of the issues that policy officials struggle with in financing and delivering a complex array of services to a diverse population.
March 1995» -
Managing Care for Older Beneficiaries of Medicaid and Medicare: Prospects and Pitfalls
States have demonstrated that it is possible to improve care for the elderly and contain costs at the same time. Notable examples of this success are the creative home- and community-based waiver and state-funded programs operating in Wisconsin, Oregon and Washington, which have shown that people who are nursing home certifiable can be given the less restrictive services they prefer at a cost lower than nursing home care. Yet these programs and others operated by states in every part of the country can only go so far before they bump into the Medicare wall. When an elderly person needs acute care services (as they frequently do), they enter a different part of the service delivery system where Medicare is the major payer. Typically, this part of the service system is disconnected from the long-term care portion, making transitions abrupt and traumatic for consumers. Rather than working together for the maximum benefit of consumers, each part of the system is motivated to guard its resources jealously, shifting patients and their costs to the other part of the system rather than managing those costs.
September 1994 -
Managed Care for the Elderly: A Profile of Current Initiatives
The purpose of this document is to summarize the current state-of-the-art in managed care for the elderly and to provide states with background information needed to launch their own initiatives to provide quality, cost effective care to the rapidly aging population. As you will see, attempts to truly coordinate primary, preventive, acute, and long term care have been limited, but the demonstrations that do exist show promise. As the health care reform debate unfolds, it is likely that states will seek to do more to manage care for the elderly, and we hope this document provides useful, baseline information.
November 1993» -
Building Assisted Living for the Elderly into Public Long Term Care Policy: A Technical Guide for States
A recent addition to the array of long-term care services, assisted living combines the medical aspects of long-term care with a model of supported housing and social services. Definitions of asisted living vary and sometimes the services provided overlap with other models: board and care, personal care homes, residential care facilities, rest homes and others. Generally, assisted living emphasizes consumer direction over regulation. Comparing assisted living to nursing homes, Michael Rodgers, Vice President of the American Association of Homes for the Aging, says, "Our role is to assist with, rather than to do for, residents in assisted living."
September 1992» -
Building Adult Foster Care: What States Can Do Brief
This study presents a summary of each state’s regulatory, licensure, and payment policies for adult foster care within its array of long term services and supports. It also examines the influence of state Nurse Practice Acts on the scope of services available in adult foster care and identifies policy considerations for state officials who are developing or expanding the availability of adult foster care.September 2009» -
Building Adult Foster Care: What States Can Do
This study presents a summary of each state’s regulatory, licensure, and payment policies for adult foster care within its array of long term services and supports. It also examines the influence of state Nurse Practice Acts on the scope of services available in adult foster care and identifies policy considerations for state officials who are developing or expanding the availability of adult foster care.September 2009» -
Adult Foster Care: A Resource for Older Adults
Rising demand for a full array of service options and consumer preferences for home-like non-institutional settings is increasing the interest among state policy makers in adult foster care as a service for older adults. Although adult foster care may also serve individuals with developmental disabilities and other populations, the primary focus of this report is adults age 65 and older. State leaders are interested in the experience of states that developed adult foster care as part of their service array, trends in provider supply, regulations governing providers, and quality oversight practices. This report is based on the policies and practices in five states – Arizona, Maine, Oregon, Washington, and Wisconsin. The states were selected based on their approach to licensing and Medicaid coverage for this residential option.May 2008
