To follow up on a previous study, Hilltop surveyed the literature to understand the current status of legislation among states regarding academic detailing/prescriber education (AD), as well as to describe existing efforts. AD programs are established for a variety of reasons but generally prioritize a target population based on age, gender, or geographic location; drug/drug class; disease entity; or a combination of these factors.

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The Hilltop Institute, in collaboration with the Center for the Study of Democracy at St. Mary’s College of Maryland, conducted a study of potential processes for improving eligibility and enrollment procedures through linkages with other sources, including, but not limited to, enrollment in other public service programs such as the Supplemental Nutrition Assistance Program (SNAP), the National School Lunch Program (NSLP), and Temporary Assistance for Needy Families (TANF). Researchers also analyzed the two most typical approaches states use to maximize linking program eligibility processes and data between Medicaid/SCHIP and other existing public programs: a unified application procedure to determine eligibility for multiple programs, and accessing existing data from other public programs to identify potentially uninsured children participating in those programs. The report concludes with options for Maryland.

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This matrix compares managed long-term care programs currently operating in eight states: Arizona, Florida, Massachusetts, Minnesota, New Mexico, New York, Texas, and Wisconsin. The programs were compared based on the following parameters: implementation date; mandatory/voluntary geographic coverage; waiver authority; eligibility; nursing facility (NF) level-of-care required; enrollment; Medicare integration; health plans; covered Medicaid services; risk for NF care; capitation rate methodology; and rate cells.

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The Maryland Department of Health and Mental Hygiene (DHMH), on behalf of Maryland’s Money Follows the Person (MFP) demonstration, requested that The Hilltop Institute conduct a study to provide a better understanding of service utilization by Medicaid beneficiaries with traumatic brain injury (TBI) who reside in nursing facilities. This study examined nursing facility service utilization and costs for individuals with a diagnosis of TBI, anoxia, or both TBI and anoxia. Hilltop concluded that for Maryland’s MFP demonstration to succeed in its goal of transitioning persons with brain injury from institutional settings to the community, it will be important to ensure that appropriate community-based mental health services, occupational/physical/speech therapies, and durable medical equipment are available to this population. In addition, because psychotropic medication utilization is significant among this population, medication use must be carefully managed and monitored.

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The Hilltop Institute’s Director of Long-Term Supports and Services, Cynthia H. Woodcock, and Manager of Health Services Research, Al Adamson, presented a workshop on September 29, 2008 in Boston at The Spirit of Independence: 24th  National Home and Community Based Services Conference convened by the National Association of State Units on Aging. In the workshop, entitled A Methodology for Projecting a State’s Long-Term Care Costs, they discussed the methodology that Hilltop developed to project long-term care costs in Maryland for 2010, 2020, and 2030, how other states could use that methodology to project future spending, and offered guidelines on how states could facilitate change in their long-term care systems.

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The Hilltop Institute prepared a report on Medicaid Non-Emergency Medical Transportation (NEMT) in Maryland on behalf of the Maryland Department of Health and Mental Hygiene. House Bill 235, passed in the 2008 legislative session, mandated a study on the creation of a uniform statewide NEMT program, with findings to be reported to the legislature by October 1, 2008. Hilltop conducted the study, which evaluated the feasibility of creating a uniform statewide NEMT program in Maryland; any potential cost savings or potential for quality improvement; and the potential impact of the creation of such a program on local health departments. To conduct the study, Hilltop surveyed local jurisdictions and state administrators of NEMT programs across the country, and assured stakeholder involvement by presenting the study design and incorporating comments gathered at an NEMT stakeholder’s meeting, the Medicaid Advisory Committee, and the Money Follows the Person Committee.

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The Hilltop Institute prepared this resource guide intended for analysts who plan to integrate data on Medicare and Medicaid service use and costs. The Hilltop Crossover Framework is introduced in the guide as an orienting reference device for linked Medicare and Medicaid claims, and is based on a two-by-two format whereby data are arrayed by category of service—with specific reference to Medicaid crossover claims—in order to highlight the relationships between government programs and service use. The term “crossover” refers to Medicaid claims that reflect Medicare patient liability costs that state Medicaid programs cover on behalf of persons eligible under both programs—“dual eligibles” or “duals,” for short. The guide is also intended as a general introduction to Medicare and Medicaid benefits and attendant relationships for analysts who may be less familiar with one or both programs.

Also in this series are: A Framework for State-Level Analysis of Duals: Interleaving Medicare and Medicaid Data–Poster Presentation, Examining Rate Setting for Medicaid Managed Long-Term Care, Examining the Medicare Resource Use of Dually Eligible Medicaid Recipients, and Cross-Payer Effects on Medicare Resource Use: Lessons for Medicaid Administrators.

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This report describes the services The Hilltop Institute provided to the Maryland Department of Health and Mental Hygiene (DHMH) under the 2008 Memorandum of Understanding between Hilltop and DHMH. The report covers state fiscal year 2008 (July 1, 2007, through June 30, 2008). 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.

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Tony Tucker, director of special projects at Hilltop, presented a poster session at the AcademyHealth Annual Research Meeting on June 8 and 9, 2008, on the newly developed Hilltop Crossover Framework, which provides a context to examine the relationship between Medicare and Medicaid claims for dual eligibles. The development of this framework is part of the ongoing process to provide the tools necessary to better coordinate Medicare and Medicaid services for this population.

Also in this series are: A Framework for State-Level Analysis of Duals: Interleaving Medicare and Medicaid Data, Examining Rate Setting for Medicaid Managed Long-Term Care, Examining the Medicare Resource Use of Dually Eligible Medicaid Recipients, and Cross-Payer Effects on Medicare Resource Use: Lessons for Medicaid Administrators.

 

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This study, in response to the mandate of Maryland House Bill 594, analyzes Maryland’s options to increase access to long-term services, including home- and community-based services (HCBSs) such as adult medical day care, for individuals at high risk of institutionalization because of cognitive impairments, mental illness, traumatic brain injury, or other conditions, who met financial eligibility criteria in effect as of June 1, 2007. Three approaches to expand access to Medicaid HCBS were considered: Maryland could lower its nursing facility (NF) level of care (LOC) criteria to ease entry into both NFs and community-based programs; Maryland could leave its NF LOC at its current standard, but expand access to HCBS by providing enough funds to move people from the registries for the Older Adult Waiver (OAW) and Living at Home (LAH) waiver into services; or Maryland could adopt the new authority, included in the recently enacted federal Deficit Reduction Act (DRA), to create a service package of HCBS without the need for a waiver. The Hilltop Institute (as the Center for Health Program Development and Management) reviewed Maryland and seven other states and the District of Columbia, analyzed the estimated costs and effects of three approaches mentioned above, and analyzed the potential for long-term savings for a state, should it elect to lower its NF LOC.

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