Center for Health Policy Research, School of Public Health and Health Services, George Washington University Medical Center
This study reports on provisions relating to childhood lead poisoning prevention services in Medicaid managed care contract documents (service agreements and requests for proposals, RFPS). The provisions were extracted from the managed care contracts data base of the Center for Health Policy Research of the George Washington University Medical Center. The data base was constructed and is updated as part of the Center's ongoing analytic studies.' As with other Center studies of the contract documents, this is a descriptive study of how state Medicaid agencies addressed a series of contracting issues at a specific point in time.* In brief, we found that a substantial number of the 42 contract documents in the data base addressed screening enrolled children for elevated blood lead levels (EBLLS) as a duty of managed care organizations (MCOs) serving Medicaid beneficiaries. However, very few documents addressed either medical followup for children for whom screening showed EBLL or integration of medical followup with public health agency activities to identify and reduce lead hazards in the homes of enrollees with EBLL. This last finding is consistent with a major finding of our larger studies, that at the time the contract documents we analyzed were drafted, state Medicaid agencies were just beginning to consider interactions between MCOs enrolling Medicaid beneficiaries and other public agencies with health-related duties toward enrollees. We also found that the contract documents rarely identified lead-related services in either quality assurance or as a specific MCO reporting duty. Thus, while managed care is viewed as a means of providing medical homes for Medicaid children and creating administrative systems for tracking and assuring provision of care, the contract documents suggest that many states have yet to really grasp the potential of managed care to provide a tool for improving the quality of leadrelated treatment services. After setting out our methods, findings and discussion of findings, we provide the contract language excerpts on which the analysis is based.
Wehr, Elizabeth and Rosenbaum, Sara J., "Medicaid Managed Care Contracting for Childhood Lead Poisoning Prevention Services" (1998). Center for Health Policy Research. Paper 3.