title: State Medicaid and MCO-CBO contracting. The George Washington University studies.
abstract: The web of contracts between purchasers, plans, and providers will ultimately shape the American healthcare system. Managed care contracts represent a marked departure from common law principles which allowed healthcare providers to decide when and under what circumstances they would enter into a provider/patient relationship. In two studies supported by the Substance Abuse and Mental Health and Services Administration (SAMHSA), contracts for behavioral healthcare services between Medicaid agencies and MCOs, and between MCOs and community-based mental health and substance abuse organizations were examined. Contracts typically cover both mental health and substance abuse treatment services, but state-to-state variation in procedures and specific services covered is the hallmark of behavioral healthcare contracts across the board.
authors.affiliation: Office of Managed Care, SAMHSA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Goplerud
authors.forename: S
authors.initials: S
authors.lastname: Rosenbaum
mesh_terms: D002204:Capitation Fee; D014487:Centers for Medicare and Medicaid Services, U.S.; D003156:Community Mental Health Services / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D003164:Competitive Bidding; D006801:Humans; D019458:Insurance Coverage; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D008484:Medicaid / Q000458:organization & administration*; D001523:Mental Disorders / Q000628:therapy; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation; D013221:State Health Plans / Q000458:organization & administration*; D016320:Substance Abuse Treatment Centers / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D014481:United States; D014482:United States Substance Abuse and Mental Health Services Administration; D014600:Utilization Review