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Medicaid Managed Care
Medicaid managed care Medicaid and additional services in the United States through an arrangement between a state Medicaid agency and managed care organizations (MCOs) that accept a set payment – "capitation" – for these services. As of 2014, 26 states have contracts with MCOs to deliver long-term care for the elderly and individuals with disabilities. There are two main forms of Medicaid managed care, "risk-based MCOs" and "primary care case management (PCCM)." Managed care delivery systems grew rapidly in the Medicaid program during the 1990s. In 1991, 2.7 million beneficiaries were enrolled in some form of managed care. Currently, managed care is the most common health care delivery system in Medicaid. In 2007, nearly two-thirds of all Medicaid beneficiaries are enrolled in some form of managed care – mostly, traditional health maintenance organizations (HMO) and primary care case management (PCCM) arrangements. This amounted to 29 million beneficiaries, of which 19 mil ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Medicaid
Medicaid is a government program in the United States that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by U.S. state, state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant portion of their funding. States are not required to participate in the program, although all have since 1982. Medicaid was established in 1965, part of the Great Society set of programs during Presidency of Lyndon B. Johnson, President Lyndon B. Johnson’s Administration, and was significantly expanded by the Affordable Care Act (ACA), which was passed in 2010. In most states, any member of a household with income up to 138% of the federal Poverty line in the United States#Measures of poverty, poverty line qualifies for Medicaid coverage under the provisions of the ACA. A 201 ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
United States
The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 contiguous states border Canada to the north and Mexico to the south, with the semi-exclave of Alaska in the northwest and the archipelago of Hawaii in the Pacific Ocean. The United States asserts sovereignty over five Territories of the United States, major island territories and United States Minor Outlying Islands, various uninhabited islands in Oceania and the Caribbean. It is a megadiverse country, with the world's List of countries and dependencies by area, third-largest land area and List of countries and dependencies by population, third-largest population, exceeding 340 million. Its three Metropolitan statistical areas by population, largest metropolitan areas are New York metropolitan area, New York, Greater Los Angeles, Los Angel ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Managed Care
In the United States, managed care or managed healthcare is a group of activities intended to reduce the cost of providing health care and providing health insurance while improving the quality of that care. It has become the predominant system of delivering and receiving health care in the United States since its implementation in the early 1980s, and has been largely unaffected by the Affordable Care Act of 2010. ...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Health Maintenance Organizations
In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. It is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health care providers (hospitals, doctors, etc.) on a prepaid basis. The US Health Maintenance Organization Act of 1973 required employers with 25 or more employees to offer federally certified HMO options if the employer offers traditional healthcare options. Unlike traditional indemnity insurance, an HMO covers care rendered by those doctors and other professionals who have agreed by contract to treat patients in accordance with the HMO's guidelines and restrictions in exchange for a steady stream of customers. HMOs cover emergency care regardless of the health care provider's contracted status. Operation HMOs often require members to select a primary ca ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Children's Health Insurance Program
The Children's Health Insurance Program (CHIP) – formerly known as the State Children's Health Insurance Program (SCHIP) – is a program administered by the United States Department of Health and Human Services that provides matching funds to states for health insurance to families with children. The program was designed to cover uninsured children in families with incomes that are modest but too high to qualify for Medicaid. The program was passed into law as part of the Balanced Budget Act of 1997, and the statutory authority for CHIP is under title XXI of the Social Security Act. CHIP was formulated in the aftermath of the failure of President Bill Clinton's comprehensive health care reform proposal. First Lady Hillary Clinton's brainchild in the aftermath of the failing of passage of her healthcare reform work, this Legislation to create CHIP was co-sponsored by Democratic Senator Ted Kennedy and Republican Senator Orrin Hatch. Despite opposition from some conservatives ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Health Plan
Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society".World Health Organization''Health Policy'' accessed 22 March 2011(archived 5 February 2011) According to the World Health Organization, an explicit health policy can achieve several things: it defines a vision for the future; it outlines priorities and the expected roles of different groups; and it builds consensus and informs people. Different approaches Health policy often refers to the health-related content of a policy. Understood in this sense, there are many categories of health policies, including global health policy, public health policy, mental health policy, health care services policy, insurance policy, personal healthcare policy, pharmaceutical policy, and policies related to public health such as vaccination policy, tobacco control policy or breastfeeding promotion policy. Health policy may also cover topics related to ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Not-for-profit
A not-for-profit or non-for-profit organization (NFPO) is a Legal Entity, legal entity that does not distribute surplus funds to its members and is formed to fulfill specific objectives. While not-for-profit organizations and Nonprofit organization, non-profit organizations (NPO) are distinct legal entities, the terms are sometimes used interchangeably. An NFPO must be differentiated from a NPO as they are not formed explicitly for the Public good (economics), public good as an NPO must be, and NFPOs are considered "recreational organizations", meaning that they do not operate with the goal of generating revenue as opposed to NPOs. Functions An NFPO does not have the same obligation as an NPO to serve the public good, and as such it may be used to apply for Tax exemption, tax-exempt status as an organization that serves its members and does not have the goal of generating profit. An example of this is a sports club, which exists for the enjoyment of its members and thus wou ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Alaska
Alaska ( ) is a non-contiguous U.S. state on the northwest extremity of North America. Part of the Western United States region, it is one of the two non-contiguous U.S. states, alongside Hawaii. Alaska is also considered to be the northernmost, westernmost, and easternmost (the Aleutian Islands cross the 180th meridian into the eastern hemisphere) state in the United States. It borders the Canadian territory of Yukon and the province of British Columbia to the east. It shares a western maritime border, in the Bering Strait, with Russia's Chukotka Autonomous Okrug. The Chukchi and Beaufort Seas of the Arctic Ocean lie to the north, and the Pacific Ocean lies to the south. Technically, it is a semi-exclave of the U.S., and is the largest exclave in the world. Alaska is the largest U.S. state by area, comprising more total area than the following three largest states of Texas, California, and Montana combined, and is the seventh-largest subnational division i ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Wyoming
Wyoming ( ) is a landlocked U.S. state, state in the Mountain states, Mountain West subregion of the Western United States, Western United States. It borders Montana to the north and northwest, South Dakota and Nebraska to the east, Idaho to the west, Utah to the southwest, and Colorado to the south. With an estimated population of 587,618 as of 2024, Wyoming is the List of U.S. states and territories by population, least populous state despite being the List of U.S. states and territories by area, 10th largest by area, and it has the List of U.S. states by population density, second-lowest population density after Alaska. The List of capitals in the United States, state capital and List of municipalities in Wyoming, most populous city is Cheyenne, Wyoming, Cheyenne, which had a population of 65,132 in 2020. Wyoming's western half consists mostly of the ranges and rangelands of the Rocky Mountains; its eastern half consists of high-elevation prairie, and is referred to as th ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Pay For Performance (healthcare)
Pay or PAY may refer to: *A wage or salary earned for work *The process of payment Places * Pay-e Borj, a village in Lorestan Province of Iran * Pay-e Kal-e Garab, a village in Ilam Province of Iran * Pay-e Rah, a village in Khuzestan Province of Iran * Pay Lake, a lake in Minnesota, USA *Pay Nga mountain in Sweden Other * Pay (geology), the portion of a reservoir that contains economically recoverable hydrocarbons *'' Partido Alianza por Yucatán'', a political party in Mexico *The Hebrew letter Pe *Verifone Verifone, Inc. is an American multinational corporation headquartered in New York City, New York. Verifone provides technology for electronic payment transactions and value-added services at the point of sale, point-of-sale. Verifone sells merc ... (NYSE stock ticker: PAY) People with the surname Pay * Antony Pay (born 1945), English clarinettist * Dean Pay (born 1969), Australian rugby league footballer * E. J. Pay (died 1931), British labour movement activist * ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Enhanced Primary Care Case Management Program
Primary Care Case Management (PCCM), is a program of the United States government healthcare service Medicaid. It oversees the United States system of managed care used by state Medicaid agencies in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment. In the mid-1980s, states began enrolling beneficiaries in their PCCM programs in an attempt to increase access and reduce inappropriate emergency department and other high cost care. Use increased steadily through the 1990s. History In 1981, the 97th session of Congress enacted the Omnibus Budget Reconciliation Act (OBRA) which allowed state Medicaid programs to implement risk-based managed care programs as well as PCCM, pending HCFA (now known as CMS) waiver approval. The state had to meet two requirements in order to be granted HCFA approval. * The case ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Managed Care
In the United States, managed care or managed healthcare is a group of activities intended to reduce the cost of providing health care and providing health insurance while improving the quality of that care. It has become the predominant system of delivering and receiving health care in the United States since its implementation in the early 1980s, and has been largely unaffected by the Affordable Care Act of 2010. ...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
