April 2010
Missouri Department of Social Services
For the Missouri Department of Social Services, The Lewin Group examined high-cost individuals in the MO HealthNet program. For the analysis, Lewin evaluated high-cost individuals from two different perspectives: individuals whose claims history demonstrated unusually high use of certain services, specifically pharmacy, inpatient hospital and emergency room (ER) and individuals whose overall claims history demonstrated unusually high overall spending levels.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
April 2010
Missouri Department of Social Services
MO HealthNet retained The Lewin Group to conduct a comprehensive review of Missouri’s Medicaid program. The review included numerous interviews with Missouri officials, documentation review, and intensive data analysis. Specific areas of analysis included the pharmacy program, clinical services, long-term care, high volume providers, high cost participants, and non-emergency medical transport. The report includes a “big-picture” assessment of the Missouri Medicaid program and potential opportunities for organizational improvement.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
February 2010
Missouri Department of Social Services
For the Missouri Department of Social Services, The Lewin Group conducted a high-level review of MO HealthNet’s Non-Emergency Medical Transportion (NEMT) program. The review focused on the following questions: Should MO HealthNet continue to use actuarially-sound rates? What alternative reimbursement approaches might Missouri consider? What best practices have states implemented to oversee brokers and assure quality in their NEMT programs? What service or contract modifications Missouri might consider incorporating into its NEMT broker program?
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
January 2010
Missouri Department of Social Services
Under contract to the Missouri Department of Social Services, The Lewin Group conducted a review of selected areas of the MO HealthNet Clinical Services Program for potential short and longer-term cost-savings and areas in which operational effectiveness and efficiency could potentially be improved. The report focuses on the following areas: Inpatient Hospital, Outpatient Hospital, Chronic Care Improvement Program, Durable Medical Equipment, and Hospice.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
January 2010
Missouri Department of Social Services
The purpose of this report, prepared under contract to the Missouri Department of Social Services, is to present strategies for containing costs for Medicaid services in Missouri's Medicaid program, MO HealthNet. It includes short-term cost containment opportunities, as well as opportunities for operational improvement.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
January 2010
Missouri Department of Social Services
The purpose of this report, prepared under contract to the Missouri Department of Social Services, is to present strategies for containing costs for long-term care services in Missouri's Medicaid program, MO HealthNet. This report focuses on short-term cost containment opportunities, but it also previews longer-term opportunities for improving the long term care system.
Client Area: State and Local Governments
Expertise Area: Aging and Disability, Medicaid and CHIP
November 2009
Missouri Department of Social Services
Under contract to the Missouri Department of Social Services, The Lewin Group identified pharmacy savings opportunities in the MO HealthNet Program that can help the State address its near-term fiscal crisis and to favorably impact longer-range prescription drug costs.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
November 2009
New York State Department of Health AIDS Institute
The Lewin Group, in collaboration with the New York State Department of Health AIDS Institute, conducted an evaluation of New York State’s Medicaid HIV Special Needs Plan program. The study focused on the following impact areas: inpatient hospital costs and utilization, prescription drug costs and utilization, trends in overall medical costs, and the program’s effect on cost and HIV SNP enrollees’ service utilization compared to Medicaid spending had the HIV SNP initiative not been implemented.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
September 2009
Prepared for: The United States Congress Under contract to: U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services
Congress directed Secretary of Health and Human Services to describe the problems that four Medicaid regulations were intended to address and their impact, and to commission an independent study on the prevalence of these problems and the potential impacts of four of the regulations:
- Cost Limit for Providers Operated by Units of Government and Provisions to Ensure the Integrity of Federal-State Partnership (CMS-2258-P) – proposed rule published January 18, 2007
- Graduate Medical Education (CMS-2279-P) – proposed rule published May 23, 2007
- Coverage for Rehabilitative Services (CMS-2261-P) – proposed rule published August 13, 2007
- Elimination of Reimbursement Under Medicaid for School Administration Expenditures and Costs Related to Transportation of School-Age Children Between Home and School (CMS-2287-F) – final rule published December 28, 2007, final rule rescinded on June 30, 2009
Overall, we found that states do in fact have difficulty, in some instances, tracking where their Medicaid dollars go and the precise purposes to which these dollars are applied, which, in turn, creates oversight problems with CMS. There is no doubt that many of the issues raised by the Secretary and addressed in the regulations are ones that require continued focus from CMS and the states. On the other hand, we found little evidence within the states to substantiate some of the specific problems expressed by the Secretary in his 2008 report. In addition, many of the more significant concerns identified in the Secretary’s report arise from fundamental disagreements about the appropriate scope of Title XIX. In many cases, while we find that a problem raised by CMS exists in a state, we do not find any indication that the state has acted inappropriately.
The letter approving the report is available by clicking here.
Expertise Area: Medicaid and CHIP
July 2009
Minnesota Department of Human Services
The Minnesota Department of Human Services (DHS), Disability Services Division contracted with The Lewin Group to conduct a study of the infrastructure of the State’s Medical Assistance State Plan Personal Care Assistance (PCA) program. Lewin partnered with the University of Minnesota’s Institute on Community Integration on this study.
This final report analyzes the drivers of Medical Assistance expenditures in the State’s PCA program and provides recommendations to strengthen the program. While the study focuses primarily on PCA State Plan services, important considerations include how other Medical Assistance Programs (e.g., home and community-based waiver programs) provide PCA services, and the interaction between those program requirements and the PCA State Plan program.
Three interim reports were also developed for this project and are posted on this website as well:
- Interim Report #1 (dated March 31, 2009) provided a national scan of PCA programs, analyses of Minnesota PCA program enrollment and expenditure data, findings from interviews with State officials in Minnesota and other states with PCA programs, findings from stakeholder interviews, and preliminary recommendations for the State.
- Interim Report #2 (dated June 24, 2009) included findings from a series of 14 focus groups, conducted by the
University of Minnesota’s Institute on Community Integration, with recipients of PCA services and PCA workers in a variety of Minnesota Medical Assistance programs offering PCA services. The purpose of conducting these focus groups was to hear from workers about their experiences providing PCA services and from service recipients about their experiences receiving PCA services.
- Interim Report #3 (dated June 25, 2009) presented provider agency perspectives and related recommendations to strengthen and improve provider-related components of the program based on a survey of PCA provider agencies. This report also included analyses of the types of living arrangements .
Client Area: State and Local Governments
Expertise Area: Aging and Disability, Medicaid and CHIP
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