The role of Medicaid in promoting access to high-quality, high-value maternity care

The main purpose of this article is to analyze and describe the role of Medicaid in facilitating access to care for pregnant women and ensuring high-quality maternity care that is affordable. It first summarizes the federal Medicaid requirements regarding eligibility, coverage of benefits, financing, and service delivery, with a special emphasis on existing quality provisions. Then, it discusses current issues and recommends several Medicaid reforms, particularly in the area of quality assessment and improvement. All reforms, including Medicaid reforms, should seek to support the IOM-identified aims. Much of the emphais in Medicaid policy development has been focused on access to care and great need for reform remains in the area of quality assurance and improvement, and disparity reduction because the program can play a significant role in this regard as well. More broadly, health care reform may provide an opportunity to revisit key issues around access to and quality of maternity care, including the benefit package, the content of services covered in the package, the frequency with which these services should be furnished, and the development of meaningful measures to capture whether women of childbearing age, including pregnant women, regardless of insurance status, indeed receive efficient, timely, effective, safe, accessible, and woman-centered maternity care

A critical appraisal of perioperative sleep apnoea management after nasal surgery:A review of up-to-date literature supplemented by findings of a retrospective observational study

Objective: To review the current recommendations on postoperative precautions for obstructive sleep apnoea patients undergoing elective nasal surgery. Design: Retrospective cohort study. Setting: Department of Otorhinolaryngology and Anesthesiology/Intensive Care, University Teaching Hospital, Rotterdam, the Netherlands. Participants: The medical charts of 61 patients with sleep apnoea who were admitted to the post-anaesthesia care unit between 2016 and 2020, following nasal surgery were reviewed. Main outcome measures: Number of respiratory events during post-anaesthesia care unit admission that required medical intervention. Results: In all 61 patients, continuous positive airway pressure could not be used. In 13 patients (8%), decreased oxygen saturation levels were registered during the first postoperative night, and in five of these patients, supplemental oxygen was needed. No other respiratory incidents of medical interventions were registered. Conclusions: The number of clinically relevant respiratory events of obstructive sleep apnoea patients with bilateral nasal packing following nasal surgery is low. We suggest that the safety of less expensive and less scarce alternatives of postoperative observation should be explored.</p

Medicaid statistical information system (MSIS): A data source for quality reporting for Medicaid and the Children\u27s Health Insurance Program (CHIP)

Section 401 of the Children\u27s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) requires the Department of Health and Human Services (HHS) to identify and publish healthcare quality measures for children enrolled in the Children\u27s Health Insurance Program (CHIP) or Medicaid. CHIPRA also requires core measures to identify disparities by race and ethnicity, among other factors. State Medicaid and CHIP programs are currently facing significant budgetary pressures that are likely to increase with eligibility expansions and programmatic changes resulting from the Patient Protection and Affordable Care Act (PPACA). To limit the burden on states and increase the likelihood of states\u27 voluntarily reporting on core pediatric quality measures, HHS may consider utilizing existing data sources. This article examines the feasibility of utilizing Medicaid Statistical Information System (MSIS) data to identify and analyze the core children\u27s healthcare quality measures required by CHIPRA. Five key themes related to the feasibility of using MSIS as a data source for quality measures are identified: states have significant experience with data collection, performance measurement, and quality oversight for children in Medicaid and CHIP; CHIPRA provisions related to reporting of quality measures will be implemented at a time when states are facing major fiscal constraints; MSIS provides potential opportunities as it offers a rich source of data, but the difficulties in obtaining clean data should not be underestimated; MSIS has limitations; and states, the federal government, providers, and enrollees benefit from standardization in data and quality measurement

A critical appraisal of perioperative sleep apnoea management after nasal surgery:A review of up-to-date literature supplemented by findings of a retrospective observational study

Objective: To review the current recommendations on postoperative precautions for obstructive sleep apnoea patients undergoing elective nasal surgery. Design: Retrospective cohort study. Setting: Department of Otorhinolaryngology and Anesthesiology/Intensive Care, University Teaching Hospital, Rotterdam, the Netherlands. Participants: The medical charts of 61 patients with sleep apnoea who were admitted to the post-anaesthesia care unit between 2016 and 2020, following nasal surgery were reviewed. Main outcome measures: Number of respiratory events during post-anaesthesia care unit admission that required medical intervention. Results: In all 61 patients, continuous positive airway pressure could not be used. In 13 patients (8%), decreased oxygen saturation levels were registered during the first postoperative night, and in five of these patients, supplemental oxygen was needed. No other respiratory incidents of medical interventions were registered. Conclusions: The number of clinically relevant respiratory events of obstructive sleep apnoea patients with bilateral nasal packing following nasal surgery is low. We suggest that the safety of less expensive and less scarce alternatives of postoperative observation should be explored.</p

Public health insurance design for children: The evolution from Medicaid to SCHIP

In 2005 Medicaid will turn 40, a momentous event in the life of the largest and most complex of all means-tested public entitlement programs. Since 1997, Medicaid has co-existed with the State Children’s Health Insurance Program (SCHIP), a small program which covers a fraction of the number of Medicaid enrolled children but whose legislative structure looms large against its much beleaguered companion. To the unpracticed eye, SCHIP and Medicaid appear to be quite similar in design; in reality however, their differences could not be more profound, and it is in these differences that clear directions for Medicaid’s possible future become visible. It is these differences and their meaning for U.S. child health policy which are the subject of this article. The majority of States that have implemented SCHIP as a separately-administered program have opted for benefit and coverage design in the case of early childhood preventive and developmental services that are considerably less comprehensive than the standard of coverage furnished to infants and young children under Medicaid. Researchers found that all States with separate SCHIP programs cover basic well-baby and well-child care in their service agreements; however, wide variation was found among the study States in their use of coverage standards that explicitly require participating health plans to cover child development services required under Medicaid, such as anticipatory guidance (18%), lead screening (43%), and comprehensive developmental assessments (68%). In addition, only half of the study States require participating health plans to use a medical necessity standard comparable to the Medicaid standard. The authors conclude that when States are given the flexibility to do so, they tend to reduce the level of coverage to that found in standard health insurance products, rather than the level of coverage in the Medicaid Early and Periodic Screening Diagnosis and Treatment program

SCHIP-Enrolled Children with Special Health Care Needs: An Assessment of Coordination Efforts between State SCHIP and Title V Programs

This study explores how the State Children\u27s Health Insurance Program serves children with special needs and assesses the role of the Title V Maternal and Child Health Services Block Grant program in filling in gaps in coverage. It also discusses the implications of state choices on publicly-funded health coverage for pediatric health care

Changing Policy: The Elements for Improving Childhood Asthma Outcomes

This report lays out the facts and offers specific policy recommendations for success that could change the face of childhood asthma in America. These recommendations aim to make better use of programs and policies already in place, such as Medicaid and the Children\u27s Health Insurance Program (CHIP), as well as private sector insurance coverage and existing public health programs. The recommendations also underscore the importance of careful research -- scientific, practical, and community-based -- in order to continue to learn what works best and strengthen knowledge for future action. In a reformed health system, these initial efforts are not wasted tools. Instead, they become the critical platform on which further interventions would rest

The Devolution of Managed Care Contractor Duties: Analysis and Implications for Public Policy in Managed Behavioral Health Care

This Issue Brief analyzes the devolution of the legal duties assumed by managed care organizations (MCOs) in their contracts with group purchasers. Specifically, this brief examines the delegation of MCO contractual duties related to member care and services to individual network providers by comparing the language used in master contracts between purchasers and MCOs with the language contained in agreements with network health care providers who serve members covered under the master contract

High-Cadence, High-Contrast Imaging for Exoplanet Mapping: Observations of the HR 8799 Planets with VLT/SPHERE Satellite Spot-Corrected Relative Photometry

Time-resolved photometry is an important new probe of the physics of condensate clouds in extrasolar planets and brown dwarfs. Extreme adaptive optics systems can directly image planets, but precise brightness measurements are challenging. We present VLT/SPHERE high-contrast, time-resolved broad H-band near-infrared photometry for four exoplanets in the HR 8799 system, sampling changes from night to night over five nights with relatively short integrations. The photospheres of these four planets are often modeled by patchy clouds and may show large-amplitude rotational brightness modulations. Our observations provide high-quality images of the system. We present a detailed performance analysis of different data analysis approaches to accurately measure the relative brightnesses of the four exoplanets. We explore the information in satellite spots and demonstrate their use as a proxy for image quality. While the brightness variations of the satellite spots are strongly correlated, we also identify a second-order anti-correlation pattern between the different spots. Our study finds that PCA-based KLIP reduction with satellite spot-modulated artificial planet-injection based photometry (SMAP) leads to a significant (~3x) gain in photometric accuracy over standard aperture-based photometry and reaches 0.1 mag per point accuracy for our dataset, the signal-to-noise of which is limited by small field rotation. Relative planet-to-planet photometry can be compared be- tween nights, enabling observations spanning multiple nights to probe variability. Recent high-quality relative H-band photometry of the b-c planet pair agree to about 1%.Comment: Astrophysical Journal, in pres

Medicaid and Case Management to Promote Healthy Child Development

This policy brief presents options for financing and delivering case management services to low-income and special-needs children in Medicaid. The analysis builds on a literature review of case management, a review of the legal underpinnings of Medicaid case management, and consultation with experts in the fields of health care finance and program operations. It aims to inform the policy community about the importance of case management for assuring the health and development of our youngest and most vulnerable children