Medicaid

This brief summarizes the key features of the Drug Effectiveness Review Project (DERP). The DERP is a collaborative partnership between states and other government and non-profit entities that conducts systematic evidence-based reviews of pharmaceuticals. It is the largest effort to apply current best practices and evidence-based analysis to pharmacy management issues. medicaid_DERP.pdf 882.5 KB  

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  • State Design and Use of Prior Authorization Processes

    This brief summarizes six state’s experiences in implementing and operating prior authorization (PA) processes that support a preferred drug list (PDL). The PA process can be divided into three major components: Submission, Review, and Appeal. This brief examines state policy choices and experience in each of these areas. It also examines two common means these […]

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    April 17, 2009 | Filed under: Medicaid

  • State Experience in Creating Effective P&T Committees

    This brief summarizes state experience in creating and managing Pharmaceutical and Therapeutics (P&T) committees. The brief points out that states face critical issues in designing and implementing their efforts that range from the make-up of their P&T committees, to the way in which prior approval requests are submitted. medicaid_pandt.pdf 317.7 KB  

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    April 17, 2009 | Filed under: Medicaid

  • Publications

    Ideas for Managing Costs and Improving Care Delivery for High-Cost Medicaid Beneficiaries

    Chronic care is driving the cost of the Medicaid program, and the future of insurance coverage for low-income families and children depends upon success in meeting the needs of those with chronic conditions at a cost society can afford. This paper tallies the suggestions made by a group of informants who have given substantial thought […]

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    April 15, 2009 | Filed under: Care Coordination, Medicaid, Publications

  • State Policy Improvements that Support Effective Identification of Children At Risk for Developmental Delay

    The success of the ABCD Initiative provides lessons for states and other entities wishing to improve the quality of health care while controlling costs and improving efficiency.  Identifying and implementing key processes to improve state policies affecting screening in primary care are the focus of this brief.  ABCD states changed state statutes, state regulations, contracts, […]

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    April 13, 2009 | Filed under: Medicaid

  • Publications

    Medicaid Managed Care Policies Affecting Safety-Net Providers and the People They Serve – Volume III: Finance

    This report is the third of three in a series that uses findings from a literature review and an all-state survey conducted by NASHP in the fall of 2000 to examine Medicaid managed care policies related to safety-net providers and the people they serve. This third report examines state Medicaid managed care policies regarding aspects […]

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    April 9, 2009 | Filed under: Medicaid, Publications

  • Publications

    Medicaid Managed Care Policies Affecting Safety-Net Providers and the People They Serve – Volume II: Monitoring Functions and Quality

    This report is the second of three in a series that uses findings from a literature review and an all-state survey conducted by NASHP in the fall of 2000 to examine Medicaid managed care policies related to safety-net providers and the people they serve. This second report examines state Medicaid managed care policies regarding managed […]

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    April 9, 2009 | Filed under: Medicaid, Publications

  • Publications

    Medicaid Managed Care Policies Affecting Safety-Net Providers and the People They Serve – Volume I: Eligibility and Access Policies

    This report is the first of three in a series that uses findings from a literature review and an all-state survey conducted by NASHP in the fall of 2000 to examine Medicaid managed care policies related to safety-net providers and the people they serve. This first report examines state Medicaid policies regarding the inclusion of […]

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    April 9, 2009 | Filed under: Medicaid, Publications

  • Publications

    Perspectives on Using a Rapid Monitoring System: A Report from the Effective Managed Behavioral Healthcare Program Monitoring Summit

    This report looks at eight key findings of a group of state policy makers and other experts convened to discuss their experience in operating an Early Warning System (EWS) or a similar system. An EWS uses a limited set of measures and administrative processes to oversee the managed care behavioral health system and provide real-time, […]

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  • Publications

    State Budget Cuts and Medicaid Managed Care: Case Studies of Four States

    Based on information gathered from survey data and interviews with stakeholders in four states (Florida, Massachusetts, Michigan, and Oregon), this report examines the impact of Medicaid budget cuts on states’ Medicaid managed care programs. mmc_state_budget_cuts.pdf 357.4 KB  

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    April 9, 2009 | Filed under: Medicaid, Publications