Medicare Compliance & Reimbursement

CHSC resource shows best practices for dealing with poor children.

One organization has not only raised doubts about whether Medicaid is doing enough for poverty-stricken children, but also offered strategies to improve the program's efforts to catch and react to children's developmental delays.

The Center for Health Care Strategies has published "Enhancing Child Development Services in Medicaid Managed Care: Best Clinical and Administrative Practices Toolkit," a resource for health plans and other organizations for improving developmental services for low-income children.
 
Report Unveils Strategies For Service Delivery The CHCS study--based on 11 health plans' experiences--presents a framework for designing quality initiatives to improve developmental services that plans can customize to work in different clinical and administrative areas. The study offers strategies for:

• improving the delivery of services, including identifying developmental disabilities earlier;

• increasing outreach to members;

• enhancing provider partnerships;

• improving reimbursement and referral practices, and 

• recognizing potential returns on plan investment.   The CHCS study utilizes case studies and directs users to additional online practical tools. The report also presents recommendations for using standardized developmental screening tools during well-child visits to identify infants and young children with developmental delays. CHCS also details how health plans can work with primary care practitioners to reduce administrative burdens and improve workflow.

The best practices framework suggests rewarding quality care with incentives and offers suggestions on how to improve reimbursement rates for developmental screening and testing.

One participating health plan, for example, paid physicians $25 for submitting claims for these services and promoted the incentive through letters to providers and articles in a provider newsletter.

The report also provides guidance on improving return on investment for health care plans.

For instance, improving the quality of child services plan-wide may lead to improved services for not only Medicaid recipients, but all plan members.