Abstract
This article compares provider perceptions of access to services and utilization management (UM) procedures in two Medicaid programs in the same state: a full-risk capitated managed care (MC) program and a no-risk, fee- for-service (FFS) program. Survey data were obtained from 198 mental health clinicians and administrators. The only difference found between respondents in the FFS and MC sites was that outpatient providers in the MC site reported significantly lower levels of access to high-intensity services than did providers in the FFS site (p < .001). Respondents in the two sites reported similar attitudes toward UM procedures, including a strong preference for internal over external UM procedures. These findings support the conclusion that through diffusion of UM procedures, all care in the Medicaid program for persons with a serious mental illness is managed, regardless of risk arrangement. Implications for mental health services and further research are discussed.
| Original language | English |
|---|---|
| Pages (from-to) | 29-46 |
| Number of pages | 18 |
| Journal | Journal of Behavioral Health Services and Research |
| Volume | 27 |
| Issue number | 1 |
| DOIs | |
| State | Published - Feb 2000 |
| Externally published | Yes |
Bibliographical note
Funding Information:The research on which this article is based was supported by the Substance Abuse and Mental Health Services Administration through a cooperative agreement with the Center for Mental Health Services (UR7TIl1272) and a research grant from the National Institute of Mental Health (MH51410). The authors would like to acknowledge the helpful comments of three anonymous reviewers on an earlier version of this article.
Funding Information:
Medallion II (see Table 1) encompasses only the medical-psychiatric component of Medicaid behavioral health services. The capitated fee covers such services as acute inpatient hospital care and outpatient psychiatric services (including medication management and psychotherapy). However, Medicaid social-rehabilitation services, including case management, were not covered by contract, allowing CSBs to continue to bill for these using a formula based on the number of clients receiving such services from a particular CSB. Substance abuse services are not a covered benefit under the Virginia Medicaid program; these services are supported by block grant funding from the State Department of Mental Health to the CSBs.
Funding
The research on which this article is based was supported by the Substance Abuse and Mental Health Services Administration through a cooperative agreement with the Center for Mental Health Services (UR7TIl1272) and a research grant from the National Institute of Mental Health (MH51410). The authors would like to acknowledge the helpful comments of three anonymous reviewers on an earlier version of this article. Medallion II (see Table 1) encompasses only the medical-psychiatric component of Medicaid behavioral health services. The capitated fee covers such services as acute inpatient hospital care and outpatient psychiatric services (including medication management and psychotherapy). However, Medicaid social-rehabilitation services, including case management, were not covered by contract, allowing CSBs to continue to bill for these using a formula based on the number of clients receiving such services from a particular CSB. Substance abuse services are not a covered benefit under the Virginia Medicaid program; these services are supported by block grant funding from the State Department of Mental Health to the CSBs.
| Funders | Funder number |
|---|---|
| State Department of Mental Health | |
| National Institute of Mental Health | MH51410 |
| Substance Abuse and Mental Health Services Administration | |
| Center for Mental Health Services | UR7TIl1272 |
| College of Social and Behavioral Sciences, University of Northern Iowa |
