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Biomedical subjects

Joel Teitelbaum

Publications and source records attributed to Joel Teitelbaum.

12 recordsLinked to original sources
PubMed2003

Reasonable modification or fundamental alteration? Recent developments in ADA caselaw and implications for behavioral health policy.

This issue brief examines the concept of fundamental alteration under the Americans with Disabilities Act (ADA); specifically it considers when proposed modifications of public programs under Title II of the ADA will be considered to amount to the type of fundamental alteration that lies beyond judicial power to compel. The issue of when a program change constitutes a fundamental alteration is important in state community integration planning efforts, since these types of changes will require legislative action.

Civil Rights↗
PubMed2002

Evaluation of agreements between managed care organizations and providers of community-based mental illness and addiction disorder treatments.

OBJECTIVE: To analyze the scope, content, and nature of contracts between managed care organizations (MCOs) and community-based mental illness and addiction disorder treatment and prevention service providers, focusing on implications for managed care policy. STUDY DESIGN: Qualitative and quantitative document content analysis. METHODS: We reviewed and coded 107 provider contracts from 17 states. Data were aggregated on MCO and provider demographics, scope of services, contractual obligations, and financial reimbursement mechanisms. Results were compared with those from a similar study conducted in 1996 with a sample of 50 contracts to identify changes over time. RESULTS: The MCOs purchased relatively few services from providers, omitting many services integral to the proper management of mental illness and addiction disorders. Service duties were often ambiguously described, leading to potentially significant and unanticipated financial risk for providers. The MCOs exert strong control over treatment decision making. Capitation and other risk-based payment arrangements are increasingly common, although most continue to use fee-for-service reimbursement methods. Contracts are structured to remove provider bargaining power; they allow MCOs to unilaterally amend all provisions on notice and without negotiation and permit termination "at will." CONCLUSIONS: Managed care contracts favor the needs of the managed care industry and are constructed to (1) shift significant amounts of financial risk onto providers and (2) manage and restrain providers' choices over the use of benefits through close oversight, financial controls, and incentives. Because a signed contract is a precondition to access to patients and insurance revenues, health professionals must sign them and indicate a general inability to negotiate their terms.

Community Mental Health Services↗