Reforming managed care certification of mental health services.
This article examines the issues associated with the current managed care delivery system for certification of mental health services, including pain management. Inconsistencies in dispositions having impacts upon patient care appear to be inherent in the current peer review certification system. Issues related to public assistance clients will be given particular attention. After introducing the issues, this article reviews the literature to survey what facets have been the subjects of academic research and reflection. It then presents case examples of inconsistencies, followed by recommendations for a model with checks and balances. In conclusion, creation of an independent monitor group is recommended.
Gomez
Madeleine Y
MY
PsycHealth Ltd, Evanston, IL, USA.
Hall
Mitch
M
D002568:Certification; D018166:Health Care Reform; D006801:Humans; D007345:Insurance Claim Review; D019458:Insurance Coverage; D008329:Managed Care Programs / Q000191:economics / Q000592:standards*; D008605:Mental Health Services / Q000191:economics / Q000592:standards*; D018024:Peer Review, Health Care; D011785:Quality Assurance, Health Care; D012949:Social Work, Psychiatric / Q000191:economics / Q000592:standards