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Providing High-Quality Services to Children with Special Health Care Needs (CSHCN) Under Managed Care

Designing Managed Care Systems

Meeting the Needs of Children with Special Health Care Needs

Presenter:

Ian Hill, M.P.A., M.S.W., Associate Director, Health Systems Research, Inc., Washington, D.C.


In developing managed care delivery systems for CSHCN, State policymakers and program officials must resolve a series of critical design issues to ensure that these systems can provide high-quality care to this special population.

Ian Hill, Associate Director of Health Systems Research, Inc., discussed the policy options available to design alternative service delivery and financing arrangements, noting that a major goal is to identify integrated models that possess the flexibility and capacity to meet the full range of these children's needs.

Mr. Hill discussed some of the key design questions that States need to address when developing these models, including:

  • How managed care plans should identify CSHCN.
  • What services will be covered for CSHCN through the managed care system.
  • What providers should be included in the managed care network.
  • How services to CSHCN might be delivered and financed.
  • The elements of a comprehensive quality assurance system.

In addition, Mr. Hill presented a range of options for addressing each of these questions along with examples of States' approaches to the design of managed care systems for CSHCN.

References

Excerpts from Hill I, Schwalberg R, Butler P. Delivering and Financing Services for Vulnerable Children Under Health Care Reform. Health Systems Research, Inc. November 1995.

Hill I, Schwalberg R, Chait E. Delivering and Financing Services for Children with Special Health Care Needs Under Managed Care: Designing Options for Vermont Officials. Health Systems Research, Inc. September 1995.

Hill I, Schwalberg R, Chait E. Assessing the Risk of Women and Children Enrolled in Managed Care: Design Options for South Carolina Officials. Health Systems Research, Inc. August 1995.


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