Hilltop’s Director of Special Research and Development, Tony Tucker, gave this presentation to the Maryland Department of Health and Mental Hygiene (DHMH) Long-Term Care Payment Advisory Committee (LTC PAC). It describes RUGs, the LTC minimum data set (MDS) as it is used to assign RUGs to nursing facility (NF) residents, and Hilltop’s process to refine MDS data to examine patterns of care. Hilltop refined MDS data were also used to show the distribution of Maryland’s NF residents, as well as measures of length of NF stays, by RUG level and payor.
This presentation, delivered by Charles Milligan to the Maryland Department of Health and Mental Hygiene (DHMH) Long-Term Care Payment Advisory Committee (LTC PAC), describes findings from a Hilltop study that examined the Medicaid nursing facility (NF) payment systems of all 50 states and the District of Columbia. It also compares Maryland’s payment system to that in other states.
The Maryland Kids First Act was signed into law in May 2008. It directed the Maryland Department of Health and Mental Hygiene (DHMH) to use the state’s personal income tax system to target outreach efforts to children who might be eligible for Medicaid or CHIP (in Maryland, known as the Maryland Children’s Health Program, or MCHP). To study whether this outreach strategy is effective, the State Health Access Reform Evaluation (SHARE) Program, a national program of the Robert Wood Johnson Foundation, commissioned DHMH and its partner, The Hilltop Institute, to evaluate the outreach effort. Hilltop researchers performed the study on behalf of DHMH. The brief highlights the findings and identifies 10 lessons learned from the experience so far, addressing issues such as data-sharing, health literacy, inclusion/exclusion criteria, tracking mechanisms, and the circumstances under which legislation is necessary in order to implement tax-based outreach.
This report describes the services The Hilltop Institute provided to the Maryland Department of Health and Mental Hygiene (DHMH) under the 2009 Memorandum of Understanding between Hilltop and DHMH. The report covers state fiscal year 2009 (July 1, 2008, through June 30, 2009). Hilltop’s interdisciplinary staff provided a wide range of services, including: Medicaid acute care program development and policy analysis; HealthChoice program support, evaluation, and monitoring; behavioral health and dental care analyses; research, analysis, and program development related to long-term supports and services; Medicaid rate setting–payment development and financial monitoring; and data management and web-accessible database development.
This report is the second in a series that explores the cross-payer effects of providing Medicaid long-term supports and services on Medicare acute care resource use. Patterns of Medicaid eligibility, as well as resource use under both Medicare and Medicaid are examined primarily within the context of service use-based groups that might be used to set rates for Medicaid capitation payments for managed long-term care. The report examines, in further detail, the overall patterns of resource use, and presents and simulates a rate setting system to cover the Medicaid portion of costs associated with coordinated care in an integrated Medicare and Medicaid environment. The relationship between CMS Hierarchical Condition Categories-based risk adjustment that is used to establish payments for Medicare Advantage plans and Medicaid resource use is also explored.
Also in this series are: A Framework for State-Level Analysis of Duals: Interleaving Medicare and Medicaid Data, A Framework for State-Level Analysis of Duals: Interleaving Medicare and Medicaid Data–Poster Presentation, Examining the Medicare Resource Use of Dually Eligible Medicaid Recipients, and Cross-Payer Effects on Medicare Resource Use: Lessons for Medicaid Administrators.
Comprehensive assessments play an important role as states seek to provide more long-term care (LTC) in home and community-based service (HCBS) settings rather than in institutions. A well-designed assessment instrument identifies the full range of a consumer’s service needs so that they can be addressed, thus preventing or delaying the need for institutionalization. This report identifies trends and emerging best practices in comprehensive assessments for HCBS. Assessment instruments from 13 states are included in the analysis.
This presentation to the federal Medicaid Commission on September 6, 2006, discusses Medicaid reimbursement for private providers, safety-net providers, public providers, and managed care organizations.
This presentation to the federal Medicaid Commission on September 6, 2006, addresses the Medicaid federal-state funding match, oversight to detect fraud and abuse, workforce issues that may impact Medicaid reform strategies, and the flexibility offered by Medicaid waivers.
This report provides an update on the overall performance of HealthChoice, Maryland’s Medicaid managed care program, regarding access and utilization for select populations. The update focuses on HealthChoice performance for calendar years (CYs) 2003 through 2007.
The Hilltop Institute conducted an independent assessment of Salud!, New Mexico’s Medicaid managed care program, to provide an analysis of access to and quality of care for children with persistent asthma and adults with diabetes enrolled in the program. The assessment addressed three policy questions specific to the effectiveness of care delivered to people with chronic disease by the Salud! managed care organizations (MCOs): how does the performance of MCOs in Salud! compare to the performance of other MCOs in the western region of the United States?; have quality of and access to care for people with chronic conditions improved?; and have racial/ethnic and regional disparities in access and quality been reduced? Hilltop researchers found that utilization of primary care and preventive/ambulatory care services among enrollees with chronic conditions is high and that emergency room visits for the conditions studied decreased, demonstrating improvements in both access to and quality of care. To view the New Mexico press release on this report, click here.