Managed Care Contracting
Overview
The Center's initiatives in the area of managed care systems for low-income, publicly insured individuals play a central role in the evolution of Medicaid managed care. As a part of this work, the Center:
- Conducts ongoing analytic studies of Medicaid managed care contracts and provider agreements, focusing on areas such as children's health, substance abuse treatment, and mental health services. These studies assess the evolving relationship between State Medicaid agencies and managed care plans and the potential impact on beneficiaries and safety-net providers.
- Maintains the only database of state Medicaid agency, risk-based managed care general service agreements and carve-out contracts.
- Develops sample managed care purchasing specifications in areas of special concern, such as diabetes, HIV/AIDS, data reporting, and children enrolled in Medicaid and State Children's Health Insurance Programs (SCHIP).
- Trains staff at State Medicaid, public health, and SCHIP agencies.
Along with the core support of the Packard Foundation, significant support for these projects comes from several agencies within the US Department of Health and Human Services, including the Health Resources and Services Administration, the Centers for Disease Control and Prevention, and the Substance Abuse and Mental Health Services Administration.
Negotiating the New Health System, 4th Edition
Negotiating the New Health System, 3rd Edition. The Third edition may have broken links as it is still in transition. Please bear with us; it has been posted, in the meantime, for potential usefulness, though it may not be entirely usable. Please contact us if you have any problems.
Related Publications
Publications Available Online
Vernon, J.A., Trujillo, A., Rosenbaum, S., and DeBuono, B. Low Health Literacy: Implications for National Health Policy. October 2007.
Rosenbaum, S. An Analysis of Proposed Rules Restricting Federal Medicaid Payments for Publicly Supported Health Care Services. American Health Lawyers Association, Health Lawyers Weekly, v. 5, No. 10 (Mar. 10, 2007).
Biles, B., and Adrion, E. Payments to Medicare Advantage Exceed Fee-for-Service Costs: Options for Medicare Savings from 2007 through 2011. Commonwealth Fund. September 2006.
Rosenbaum, S. Defined-Contribution Plans and Limtied-Benefit Arrangments: Implications for Medicaid Beneficiaries. America's Health Insurance Plans (AHIP). September 2006.
Rosenbaum, S., Wilensky, S., Shin, P., and Whittington, R. Managed Care and Medi-Cal Beneficiaries with Disabilities: Assessing Current State Practice in a Changing Federal Policy Environment. The California Endowment. July 2006.
Markus, A., Rosenbaum, S., Stein, R.E.K., and Joseph, J. Policy Brief #6: From SCHIP Benefit Design to Individual Coverage Decisions. January 2006.
Borzi, P.C., Regenstein, M., Repasch, L., Cyprien, S., and Rosenbaum, S. How Care Is Managed: A Descriptive Study of Current and Future Trends in Care and Cost Management Practices Under Private Sector Employee Benefit Plans. U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation. December 2002, March 2004 (Posted August 2005).
Mauery, R.D., Kamoie, B., Blake, S.C., and Levi, J. Public Health Communicable Disease Reporting Laws: Managed Care Organizations' Laboratory Contracting Practices and Their Implications for State Surveillance and Reporting Statutes. Centers for Disease Control and Prevention. October 2003 (Posted February 2004).
Rosenbaum, S., Stewart, A., Cox, M., and Lee, A. The Epidemiology of U.S. Immunization Law: A National Study for The National Immunizations Prgram, Centers for Disease Control and Prevention, Medicaid Coverage of Immunizations for Non-Institutionalized Adults. November 2003.
Rosenbaum, S., Kamoie, B., Mauery, D. R., Walitt, B. (2003). Medical Necessity in Private Health Plans: Implications for Behavioral Health Care. DHHS Pub. No. (SMA) 03-3790. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. November 2003.
Rosenbaum, S., Kamoie, B., Collins, C., Zuvekas, A., Feder, J., and Claxton, G. Analysis of CareFirst's Performance as a Charitable Not-for-Profit Health Insurance Company in the National Capital Area. Report to the DC Appleseed Center for Law and Justice. October 2003.
Mauery, R., Collins, J., McCarthy, J., McCullough, C., and Pires, S. Contracting for Coordination of Behavioral Health Services in Privatized Child Welfare and Medicaid Managed Care. Center for Health Care Strategies, Inc. June 2003.
Sage, W.M., Hyman, D., and Greenberg, W. Why Competition Law Matters to Health Care Quality. Health Affairs, Vol. 22, No. 2, March/April 2003, available at www.healthaffairs.org.
Rosenbaum, S. Managed Care and Patients Rights (Editorial). Journal of the American Medical Association, Vol. 289, No. 7, February 19, 2003.
Rosenbaum, S., Sonosky, C., Shaw, K., and Mauery, D.R. Policy Brief #5: Behavioral Health and Managed Care Contracting Under SCHIP. September 2002.
Harvey, J., Vaquerano, L., Nolan, L., and Sonosky, C. School-Based
Health Centers and Managed Care Arrangements: A Review of State Models
and Implementation Issues. July 2002.
Rosenbaum, S., Stewart, A., and Sonosky, C. Negotiating the New Health System: Findings from A Nationwide Study of Medicaid Primary Care Case Management Contracts. Center for Health Care Strategies, Inc. June 2002.
Wilson, M., Levi, J., and Owen, A. Mitigating Financial Risk with HIV/AIDS Patients. May 2002. (Download PDF file now)
Mauery, D.R., Teitelbaum, J., Lerman, J., Rosenbaum, S. Behavioral Health Issue Brief 15 & 16: An Analysis of Contracts for the Delivery of Managed Behavioral Health Care Services in State Correctional Facilities. February 2002. 49 pages. 1.58MB
Rosenbaum, S., Markus, A., Teitelbaum, J. Behavioral Health Issue Brief 20: The Devolution of Managed Care Contractor Duties: Analysis and Implications for Public Policy in Managed Behavioral Health Care. December 2001. 36 pages. 1.13MB
Shaw, K. and Rosenbaum, S. Access to Pediatric Services under Medicaid Managed Care in the District of Columbia. December 2001(Download PDF file now)
Rosenbaum, S., Shaw, K., and Sonosky, C. SCHIP Policy Brief #3: Managed Care Purchasing Under SCHIP: A Nationwide Analysis of Freestanding SCHIP Contracts. December 2001. (Download PDF file now)
Rosenbaum, S., Mauery, D.R., Kamoie, B. Behavioral Health Issue Brief 11 & 12Care Coordination and Physical and Behavioral Service Integration in Managed Care Contracts: Analysis and Sample Purchasing Specifications. May 2001. 23 pages. 712K
Rosenbaum, S., and Sonosky, C. An Analysis of the Bush Administration’s Proposed Medicaid Managed Care Regulations. September 2001. (Download PDF now)
Rosenbaum, S., and Sonosky, C. An Analysis of the Bush Administration’s Proposed Medicaid Managed Care Regulations: A Comparison of Selected Provisions of the January 19, 2001, Medicaid Managed Care Rule and the August 20, 2001, Notice of Proposed Rulemaking (NPRM). September 2001. (Download PDF now)
Rosenbaum, S., Mauery, D.R., Teitelbaum, J. Behavioral Health Issue Brief 14: An Overview of Legal Developments in Managed Care Caselaw and Selected Case Studies of Legal Developments in State Contracting for Managed Behavioral Health Services. August 2001. 26 pages. 840K
Rosenbaum, S. An Overview of Managed Care Liability: Implications for Patient Rights and Federal and State Reform. AARP Public Policy Institute. March 2001.
Rosenbaum, S, and Sonosky, C. Federal EPSDT Coverage Policy: An Analysis of State Medicaid Plans and State Medicaid Managed Care Contracts. December 2000.
Rosenbaum, S., Smith, B.M. Issue Brief 10: Medicare, Managed Care, and Behavioral Health Care. November 2000. 20 pages. 721K
Rosenbaum, S., Teitelbaum, J., Mauery, D.R. Behavioral Health Issue Brief 9: An Evaluation of Agreements Between Managed Care Organizations and Community-Based Mental Illness and Addiction Disorder Treatment and Prevention Providers. March 2000. 34 pages. 1.18MB
Rosenbaum, S., Mauery, R., Blake, S., and Wehr, E. Public Health in a Changing Health Care System: Linkages Between Public Health Agencies and Managed Care Organizations in the Treatment and Prevention of Sexually Transmitted Diseases. Henry J. Kaiser Family Foundation. March 2000.
Rosenbaum S., Teitelbaum, J. Behavioral Health Issue Brief 7: Designing a Complaint and Grievance System and Other Member Assistance Services Under Medicaid Managed Care. February 2000. 13 pages. 455K
Rosenbaum S., Teitelbaum, J., and Mauery, R. Negotiating the New Health System: A Nationwide Study Of Medicaid Managed Care Contracts, (3rd Edition) Vol. 1. Special Report: Mental Illness And Addiction Disorder and Medicaid Managed Care. 2000.
Rosenbaum, S., Teitelbaum, J., and Silverstein, R. The Americans With Disabilities Act: Implications for Managed Care for Persons with Mental Illness and Addiction Disorders. The Managed Behavioral Health Care Issue Brief Series #5 & 6. November 1999.
Rosenbaum S., Teitelbaum, J. Behavioral Health Issue Brief 4: Cultural Competence in Medicaid Managed Care Purchasing: General and Behavioral Health Services for Persons With Mental and Addiction-Related Illnesses and Disorders. May 1999. 18 pages. 666K
Rosenbaum, S. Approaches for Assuring Access to Quality Health Care Through State Contracts with Managed Care Plans. In Access to Health Care. Kaiser Commission on Medicaid and the Uninsured, 1999.
Teitelbaum, J., Mauery, R., and Rosenbaum, S. Sub-State Purchasing of Managed Behavioral Health Care: An Analysis of County-Level Managed Care Contracts. Substance Abuse and Mental Health Services Administration. October 1999.
Rosenbaum S., Teitelbaum, J. Behavioral Health Issue Brief 4: Cultural Competence in Medicaid Managed Care Purchasing: General and Behavioral Health Services for Persons With Mental and Addiction-Related Illnesses and Disorders. May 1999. 18 pages. 666K
Kenney, K.A., Maloy, K.A., and Kreling, B.A. Experiences of HIV-Infected Beneficiaries in the Move to Mandatory Medicaid Managed Care in Three States. March 1999.(Download PDF now)
Teitelbaum, J., Rosenbaum S., Burgess, W., DeCourcy L. Behavioral Health Issue Brief 3: Selected Key Issues in the Development and Drafting of Public Managed Behavioral Health Care Carve-Out Contracts. December 1998. 10 pages. 420K
Rosenbaum S., Teitelbaum, J. Behavioral Health Issue Brief 1: Coverage Decision-Making in Medicaid Managed Care: Key Issues in Developing Managed Care Contracts. May 1998. 9 pages. 391K
Wehr, E., Rosenbaum, S., Shaw, K., and Valencia, R. Managing Child Welfare: An Analysis of Contracts for Child Welfare Service Systems. 1999.
Wehr, E., Fagan, Blake, S., and Rosenbaum, S. An Analysis of HIV/AIDS Related Provisions of Medicaid Managed Care Contracts: A Focused Study. June 1998.
Rosenbaum, S., Shin, P., Zakheim, M., Shaw, K., and Teitelbaum, J. Negotiating
the New Health System: A Nationwide Study of Medicaid Managed Care Contracts
(2nd Edition) Special Report: Mental Illness and Addiction Disorders Treatment
and Prevention. May 1998.
Rosenbaum, S., Teitelbaum, J., Priebe, L., Kirby, C., and Klement, T. An Overview of Medicaid Managed Care Litigation. The Managed Behavioral Health Care Issue Brief Series #2. November 1998.
Rosenbaum S., and Teitelbaum, J. Coverage Decision-Making in Medicaid Managed Care. The Managed Behavioral Health Care Issue Brief Series #1. May 1998.
Mauery, D.R., Rosenbaum, S., Woolley, Wehr, E., and Sofaer. An Evaluation of Emerging Relationships Through Memoranda of Understanding Between Managed Care Organizations and Public Health Agencies: Implications for Population-Based Communicable Disease Prevention and Control Programs and Public Health Policy. 1998.(Download PDF now)
Rosenbaum, S., Silver, K., and Wehr, E. An Evaluation of Contracts between Managed Care Organizations and Mental Health and Substance Abuse Treatment and Prevention Agencies. 1997.
Rosenbaum, S., Silver, K., and Wehr, E. An Evaluation of Contracts between State Medicaid Agencies and Managed Care Organizations for the Prevention and Treatment of Mental Illness and Substance Abuse Disorders. 1997.
Articles Published in Professional Literature
Kamoie, B., Rosenbaum, S., and Stange, P. Implementation and Management of Public Health Programs in a Managed-Care Legal Framework. In Law in Public Health Practice, edited by R. Goodman, et al., New York: Oxford University Press, 2003.
Rosenbaum, S., Skivington, S., and Praeger, S. Public Health Emergencies and the Public Health/Managed Care Challenge. The Journal of Law, Medicine and Ethics, Special Supplement to Volume 30:3 (Fall 2002), p. 63-69.
Rosenbaum, S., Smith, B., Sonosky, C., Repasch, L., and Markus, A. Devolution of Authority and Public Health Insurance Design: National SCHIP Study Reveals An Impact on Low-Income Children. Houston Journal of Health Law and Policy, Vol. 1, No. 1, Symposium 2001
Rosenbaum, S., et al. "Who Should Determine When Health Care is Medically Necessary?" 340 NEJM 3 (January 21, 1999).
Rosenbaum, S. "Negotiating the New Health System: Purchasing Publicly Accountable Managed Care," 14 Am Jour. Prev. Med. 3S (April, 1998).
Rosenbaum, S., and Richards, T. "Managed Care and Public Health Practice," Journal Public Health Management Practice 2:3 (1996).
Rosenbaum S., Shin P., Mauskopf, A., and Zuvekas, A. "Medicaid Managed Care and the Family Planning Free Choice Exemption: Beyond the Freedom to Choose." Journal of Health Policy, Politics and Law 1997; 22(5): 1191-1214.
Rosenbaum, S. "Contemporary Managed Care: Readings in Structure, Operations, and Public Policy; The Managed Care Blues and How to Cure Them." [review essay] Journal of Health Politics, Policy and Law 24:5, October, 1999 pp. 1219-1230.
Rosenbaum S., Shin P., Mauskopf A., Funk K., Stern G., and Zuvekas A. Beyond the Freedom to Choose: Medicaid Managed Care and Family Planning. Western Journal of Medicine 1995; 103 [suppl]: 33-38.
Other Publications
Blake, S., Mauery, R., and Rosenbaum, S. Medicaid Managed Care and
Reproductive Health: A Focused Study of State Medicaid Managed Care Contracts.
Prepared for the Henry J. Kaiser Family Foundation. (forthcoming)
Repasch, L., and Wehr, E. The Role of Pharmacy Benefits Management
Services in Medicaid Managed Care. September 1999.
Blake, S., and Wehr, E. Asthma and Managed Care: A Focused Study of Asthma-Related Medicaid Managed Care Contract Provisions. Report to the Centers for Disease Control and Prevention. February 1999.
Rosenbaum, S., Markus, A., and Repasch, L. An Overview of Data Submission Requirements Applicable to Managed Care Organizations under State Medicaid Managed Care Contracts.
Blake, S., Rosenbaum, S., and Wehr, E. Contract Specifications for Sexually Transmitted Disease (STD) Services in Medicaid Managed Care Plans. A Focused Study for the Centers for Disease Control and Prevention. April 1997.
