来源类型 | Research Reports
|
规范类型 | 报告
|
DOI | https://doi.org/10.7249/RR1802
|
来源ID | RR-1802-ASPEC
|
| Examining the Implementation of the Medicaid Primary Care Payment Increase |
| Justin W. Timbie; Christine Buttorff; Virginia Kotzias; Spencer R. Case; Ammarah Mahmud
|
发表日期 | 2017
|
出版年 | 2017
|
页码 | 72
|
语种 | 英语
|
结论 |
High Provider Participation Rates in Medicaid Pre-Implementation- For most states, primary care provider participation was generally viewed as high preceding the policy.
- Providers who decline to participate in the Medicaid program tend to do so because of low reimbursement rates, administrative difficulties, and challenges associated with caring for Medicaid patients.
Implementation Complicated by Limited Time Line- States did not receive final guidance until two months before the policy was supposed to begin and additional clarification was required subsequently. This delayed states' ability to provide attestation guidance to providers, which, in turn, delayed states' and MCOs' efforts to configure claims-processing systems and initiate payments.
Implementation Challenges Posed by Provider Eligibility Criteria and Attestation Processes- A large number of physicians who met the eligibility criteria viewed themselves as specialists rather than primary care physicians.
- Several respondents suggested that the eligibility criteria failed to reflect the way primary care was delivered in many states — particularly by excluding advanced practice nurses.
No Formal Evaluations Conducted by State-Level Stakeholders; Perception of Limited Impact- Most respondents indicated that the policy had, at best, a modest impact on incentivizing higher rates of provider participation.
- Respondents in most states noted that increased payments over a span of only two years did not provide a potent incentive for physicians to make investments needed to expand their participation in Medicaid.
Patients and Providers Realized Benefits- Most respondents suggested that the program was beneficial and helped keep Medicaid providers "afloat" for the duration of the policy.
|
摘要 |
- Additional lead time would help states to ensure that policies and procedures critical to program function are in place before launch and reduce the need to retool or revise midstream.
- Clearer eligibility requirements could ensure a rapid start to the program.
- Given the complexities of the policymaking and implementation environment, clear, bidirectional communication with key stakeholders is important to ensure a smooth implementation process.
- By performing targeted outreach to stakeholders who fall outside of existing communication channels or stakeholder groups (e.g., primary care providers not currently enrolled in Medicaid), states may be able to expand program participation.
- Web-based attestation forms that are securely and centrally collected could reduce administrative burdens on providers.
- The need to make payments retroactively or to recoup monies that were improperly disbursed and the protracted period over which providers were able to attest, places a large burden on the state, MCOs, and providers. Properly sequencing eligibility determinations and the initiation of enhanced payments and ensuring that they align with a policy's start date would substantially lower the burden on all stakeholders.
- Many respondents urged CMS to allow for more flexibility in implementing similar payment policies that better reflect the primary care delivery system in the state and that are complementary with other ongoing payment and delivery reforms.
- Respondents reported that health care providers would have been more inclined to make investments to expand their participation in Medicaid had the federal government provided full funding for a period longer than two years.
|
主题 | Affordable Care Act
; Health Care Access
; Health Care Costs
; Health Care Program Evaluation
; Medicaid
; Primary Care
|
URL | https://www.rand.org/pubs/research_reports/RR1802.html
|
来源智库 | RAND Corporation (United States)
|
引用统计 |
|
资源类型 | 智库出版物
|
条目标识符 | http://119.78.100.153/handle/2XGU8XDN/108481
|
推荐引用方式 GB/T 7714 |
Justin W. Timbie,Christine Buttorff,Virginia Kotzias,et al. Examining the Implementation of the Medicaid Primary Care Payment Increase. 2017.
|
文件名:
|
x1495316258322.jpg
|
格式:
|
JPEG
|
文件名:
|
RAND_RR1802.pdf
|
格式:
|
Adobe PDF
|
除非特别说明,本系统中所有内容都受版权保护,并保留所有权利。