Texas Register Publishes Changes to Medicaid Managed Care and Other Services
August 29, 2006 by Jerri Lynn Ward, J.D.
Filed under Medicaid
Texas Health and Human Services Commission (HHSC) has adopted new rules that affect various provisions of Chapter 353 Medicaid Managed Care. The following rules are amended (from the August 25 Texas Register):
§353.2, Definitions; §353.3, Experience Rebate in the Managed Care Program; §353.403, Enrollment; §353.405, Marketing; §353.407, Requirements of Health Maintenance Organizations; §353.409, Scope of Services; §353.411, Accessibility of Services; §353.413, Managed Care Benefits and Services for Children Under 21 Years of Age; §353.415, Member Complaint Procedures; §353.417, Quality Assessment and Performance Improvement; and §353.419, Financial Standards.
You may look up the appropriate sections in the Texas Administrative Code (TAC) here.
On behalf of the Texas Department of Disability Services (DADS), HHSC amends, adds a new section, and repeals sections of Chapter 2, Subchapter F, regarding Continuity of Services–State Mental Retardation Facilities. Read about these changes in detail here. The corresponding TAC sections can be found here.
HHSC re-advertises its Request for Proposals “for consultant services to assist the state of Texas in optimization of case management to enhance the quality outcomes and cost savings.” Proposals are due by 2:00 p.m. CT on September 5, 2006. Also found in that section are public notices and corrections.
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Managed Care; Anatomy of a Mass Medical Movement. 2000.
The Rise and Fall of Managed Care: A Comprehensve History of a Mass Medical Movement. 2001.
Rise and Fall of Managed Care: History of the Mass Medical Movement. 2002.
“The author documents that despite promises of managed care zealots, we have a sad healthcare landscape of crippled academic medical centers, dissatisfied patients, uninsured, chronically ill and elderly citizens, and demoralized physicians: with NO cost savings. Managed care produced, however, ‘monetarization’ of medicine, multi-million dollar consulting firms, and Wall Street riches. Dr. Smith wisely reminds us that the best way to care for patients is ‘care for the patient.’ It is not too late to rediscover that the most cost effective care is that which is competent and compassionate.”
“Dr. Smith has given us a very readable but chilling chronicle of the rise and fall of the managed care era in medicine, [and] it’s demise in an avalanche of greed and bankruptcy. [The] tragic legacy of this ill-conceived plan: disgruntled patients, uninsured citizens, demoralized physicians, and crippled academic medical centers. All this with the burden of increased costs, as major resource went not to research of patient care, but to administration, regulation, and stockeholders. Fortunately, the public has finally boecome aware of the failure of the mistaken social experiment.”
Since the early 1970s, rising medical costs resulted in a profusion of healthcare plans and criticism of the profession of medicine: a confusing, chaotic, divisive setting for providing medical care. Little or no communication took place between those who purchased medical insurance plans and those who provided medical services—physicians, dentists, hospitals, and other providers. Promotion of managed care plans took on an excited, carnival atmosphere generating promise that a glorious, new era was approaching.
Since doctors order most medical care, managed care proponents emphasized the importance of controlling practices of doctors. They claimed extensive changes were needed, that almost any criticism against the profession of medicine was warranted. Enterprising economists, entrepreneur consultants and a host of others became self-styled experts and advisers to hospitals and businesses over the issue of “cost containment” and invented the imperative “runaway costs.” Accusations leveled against physicians by advocates of managed care were puzzling, disturbing, and frustrating. We were told that “managed care is what’s out there,” “business likes managed care,” and managed care is “here to stay.” The new ethic became marketplace competition, cost containment, prevention, and control.
Although most doctors at one time objected to the idea of managed care, rising sentiment against regular fee-for-service practice eventually took its toll to the point many physicians became convinced that it was up to doctors to make managed care work. Corporate benefits managers at first were opposed to the notion of managed care, but gave in to pressure from corporate management.
Managed care advocates created fear, uncertainty, and division by telling physicians that the only possibility of survival in “changing climate of health care” was to “embrace” managed care. Economists and politicians charging outright criminal activity by all physicians became the norm. Doctors and public were told that a new age had dawned, the old order was out, we had better get on board or be left behind. By declaring managed care an “unassailable truth,” managed care was propelled into a revolution, a mass movement. Yet, physicians who “embraced” managed care found themselves in an ethical and practical bind.
Enthusiasm that led to the managed care mass movement followed the same course as other mass movements—a restructuring of medical care was called for, the old was suddenly outdated, a “crisis” proclaimed, a social transformation declared!
Links:
Wyndham Hall Press, Lima, OH
Nova Science Publishers, Hauppauge, NY