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Summary: State Health Care Reform Workshops

The first State health care reform workshop was held in Baltimore, Maryland, November 28 and 29, 1995. Substance abuse officials from States that have attained an operational level of working in health care reform were invited to participate. Officials from the following States attended: Arizona, Iowa, Massachusetts, Minnesota, Nebraska, North Carolina, Oregon, and Washington.

Presentations were limited to 15–20 minutes each and were followed by open discussion among the participants. Presentation topics included managing new responsibilities before and after managed care; cost offsets; evaluating managed care; rethinking accountability; serving special populations; Medicaid block grants; contract monitoring; effects of managed care on service continuums and provider networks; and appeals, grievances, and the monitoring of managed care organizations (MCOs).

The second and third State health care reform workshops were for States that have begun implementing health care reform for substance abuse treatment services for Medicaid and other publicly supported clients. Because of the number of States that are at this level, and because of CSAT's desire to keep the workshops relatively small and informal, one workshop was held for States from the eastern portion of the United States and the next for those predominantly from the western portion of the United States. The second State health care reform workshop was held in Nashville, Tennessee, March 25 and 26, 1996. Participating officials came from Connecticut, the District of Columbia, Florida, Maryland, New York, Pennsylvania, Rhode Island, South Carolina, Tennessee, and Vermont. The third State health care reform workshop convened in Dallas, Texas, April 23 and 24, 1996. Participating States included California, Delaware, Florida, Hawaii, Kansas, Louisiana, Maryland, Michigan, Missouri, Ohio, Oklahoma, Texas, West Virginia, and Wisconsin.

For these implementation-level State workshops, presentation and open forum topics covered critical issues particular to each State's health care reform implementation efforts, financial considerations in estimating the cost of managed chemical dependency treatment services, uniform patient placement criteria (PPC), a historical overview of managed care, positive and negative aspects of managed care today, critical issues in contract development, State and MCO contracts, contract monitoring and treatment outcomes, role of the State substance abuse agency before and after managed care, developing provider networks, comprehensive section 1115 demonstration projects (Medicaid waivers), maintaining the service continuum for special populations. The average presentation time was about 30 minutes, and open forums ran for about 1–1 ½ hours. Presentations were always followed by a question-and-answer session that allowed for open dialogue.

The fourth and fifth State health care reform workshops were held for officials from States that are planning health care reform for substance abuse treatment services. Because of the number of States that are at this level, and because of CSAT's desire to keep the workshops relatively small and informal, western States participated in the fourth workshop and eastern States participated in the fifth. The fourth workshop was held in Park City, Utah, on June 25 and 26, 1996. The participating States included Alaska, Arkansas, Colorado, Idaho, Kentucky, Montana, Nevada, North Dakota, South Dakota, Utah, and Wyoming. The fifth and final State health care reform workshop was held in Chicago, Illinois, July 23 and 24, 1996. Substance abuse officials from the following States, commonwealths, and territories attended: Georgia, Illinois, Maine, Mississippi, New Hampshire, New Jersey, Puerto Rico, and the Virgins Islands.

Table 1. State Health Care Reform Workshops

^aRange = 2.76–3.48; average = 3.21.

Topics covered in these planning-level State workshops included participant introductions and brief reports on health care reform status and issues; critical issues in the development of State and MCO contracts; review of contract language (Oregon contract standards and conditions); responsibilities of the single State agency before and after health care reform; contract monitoring and treatment outcomes: quality assurance and measuring performance; maintaining the service continuum for special populations; Medicaid waivers and Federal funding after health care reform; financial considerations in estimating the cost of managed chemical dependency treatment services; developing provider networks and integrated systems (the Arizona model); and uniform PPC.

Officials from 42 States, the District of Columbia, Puerto Rico, and the Virgin Islands participated in the State health care reform workshops. For these five workshops, 27 individuals either gave presentations or facilitated discussion sessions, and there was a total of 53 presentations and discussion sessions. The workshops had a combined attendance of 210 individuals. The reader should refer to specific workshop executive summaries for agendas and participant lists.

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