Information related to managed care, behavioral health, Medicare, sustainability, and other administrative issues

New No Child Left Behind Provision Gives Schools Increased Flexibility While Ensuring All Children Count, Including Those with Disabilities

A new provision of the No Child Left Behind education reform law gives local school districts greater flexibility in meeting the law’s requirements for students with disabilities. Under final rules published in 12/09/03 Federal Register, states, school districts and schools have the flexibility to count the ‘proficient’ scores of students with the most significant cognitive disabilities who take assessments based on alternate achievement standards. Without this flexibility, those scores would have to be measured against grade-level standards and considered ‘not proficient’ when states measure adequate yearly progress.

To view the full press release, visit http://www.ed.gov/news/pressreleases/2003/12/12092003.html.

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New Medicare Law Threatens Access to Services

The Medicare law recently signed by the President may pose problems for seniors and individuals with disabilities who qualify for Medicare through the Social Security Disability Insurance (SSDI) program. Medicare is the primary health coverage for nearly five million non-elderly adults who receive SSDI—more than one fourth disabled by a mental illness.

The new law encourages Medicare privatization by offering significant financial incentives for private plans to participate. Analysts fear that these incentives could undermine the traditional Medicare program while providing little in the way of meaningful drug benefits.

To read the full article, visit http://www.bazelon.org/takeaction/alerts/1-12-04medicare.htm

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State Budget Cuts and Cutbacks in Children’s Health Coverage

The Center on Budget and Policy Priorities reports that in thirty-four states, measures to close state budget gaps have caused unprecedented cuts in Medicaid and the State Children’s Health Insurance Program (SCHIP) coverage for low-income children and families. Almost half of those losing health insurance coverage (490,000 to 650,000 people) are children.

For more information, visit http://www.cbpp.org/12-22-03health-pr.htm

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Priority Setting in Australian Mental Health Services

From Applied Health Economics and Health Policy

This paper outlines an approach to mental health administration that recognizes the scarcity of resources in mental health services, and the need for value judgments to be exercised in the way that priorities are set and in turn resources allocated. On the issue of value judgments, it recognizes that “views and recommendations” of the various groups consulted are not enough. It argues that we need to elicit preferences in a resource-constrained environment. What this means in practice is that choices have to be exercised in the sense of asking whether any extra monies, say $1 million, would be better spent on program A, B, or C (which might be interventions in care of hospital based patients, community based patients, or on preventive care, respectively).

For the full article, visit http://www.medscape.com/viewarticle/466953?mpid=23960.

(Medscape is a free service provided by WebMD; registration is required.)