Use of utilization management methods in State Medicaid programs.
This article describes the use of utilization management (UM) methods by State Medicaid programs. The use of optional UM methods range from zero in one State to eight in four States, with a median of five. A majority of States have programs for ambulatory surgery, preadmission certification, lock-in, primary-care case management, and targeted case management. Overall, no UM method was judged by States to have an adverse effect on access of quality of care. For UM methods mandated by the Medicaid program, more than one-third of the States rated physician certification as minimally effective.
Buck
J A
JA
Substance Abuse and Mental Health Services Administration, USA.
Silverman
H A
HA
D000556:Ambulatory Surgical Procedures; D019090:Case Management; D002568:Certification; D019538:Health Care Surveys; D006297:Health Services Accessibility; D008329:Managed Care Programs / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D008484:Medicaid / Q000458:organization & administration / Q000706:statistics & numerical data*; D010820:Physicians / Q000592:standards; D011787:Quality of Health Care; D013221:State Health Plans / Q000706:statistics & numerical data*; D014481:United States; D014600:Utilization Review / Q000379:methods / Q000706:statistics & numerical data*