State-Level Variability in Hospital Presumptive Eligibility Programs.
Ontology highlight
ABSTRACT:
SUBMITTER: Gibson AB
PROVIDER: S-EPMC10685880 | biostudies-literature | 2023 Nov
REPOSITORIES: biostudies-literature
Publications
State-Level Variability in Hospital Presumptive Eligibility Programs.
Gibson Alexander B AB Hendricks Wesley D WD Arnow Katherine K Tran Linda D LD Wagner Todd H TH Knowlton Lisa Marie LM
JAMA network open 20231101 11
Similar Datasets
Project description:An infant or toddler can begin the process of receiving Part C early intervention services by having a diagnosed condition with a high probability of developmental delay (Individuals with Disabilities Education Improvement Act, 2004). How states define those diagnosed conditions that begin the initiation process varies widely. Lists of diagnosed conditions were collected from state Part C websites and Part C coordinators for a descriptive analysis. Across 49 states, the District of Columbia, and 4 territories, a final list of 620 unique conditions was compiled. No single condition was listed by all jurisdictions. Hearing impairment was the condition listed by the most states (n = 38), followed by fetal alcohol syndrome (n = 34). Of the 620 conditions, 168 (27%) were listed by only 1 state, 554 (89%) were listed by fewer than 10 states, and 66 (11%) were listed by 10 or more states. Of these 66 conditions, 47 (71%) were listed by fewer than 20 states. Most of these 66 conditions (n = 48; 72.7%) had a prevalence of "very rare or rare," 8 (12%) were "common," 6 (9%) were "very common," and 4 (6.1%) were "unknown." The wide heterogeneity in the number and type of diagnostic conditions listed across states should be further investigated as it may represent imbalances in children with diagnosed conditions gaining access to Part C evaluations and individualized family service plans and potentially the services themselves across states. In addition, providing ready access to lists of diagnosed conditions is a simple step that could help states and Part C programs facilitate access to services.
| S-EPMC7177194 | biostudies-literature
Project description:ObjectiveTo assess the association between the adoption of presumptive eligibility for pregnancy Medicaid in Kansas in 2016 and timely prenatal care access.Data source2012-2019 National Center for Health Statistics natality files.Study designWe used difference-in-differences to compare outcomes before (2012-2015) and after (2017-2019) presumptive eligibility in Kansas relative to seven control group states overall and stratified by maternal education. Outcomes included first-trimester prenatal care, the month of first prenatal visit, and adequate prenatal care.Data collection/extraction methodsAll live births among adults aged 20 or older in Kansas, Idaho, Missouri, Nebraska, Tennessee, Utah, Wisconsin, and Wyoming.Principal findingsAmong all births, we found no evidence that presumptive eligibility in Kansas resulted in changes in prenatal care use. Among individuals with high school education or less, presumptive eligibility was associated with a 1.92 percentage-point increase (95% CI: 0.64, 4.35) in first-trimester prenatal care, driven by earlier month of first prenatal care visit.ConclusionsPresumptive eligibility in Medicaid non-expansion states may lead to small improvements in early prenatal care among individuals with lower education, but other interventions may be needed.
| S-EPMC9643081 | biostudies-literature
Project description: Not available
| S-EPMC11675306 | biostudies-literature
Project description:BackgroundIn Canada, although medical insurance is generally universal, significant differences exist in the provision of home oxygen therapy across the country.ObjectiveTo systematically compare the terms of reference for home oxygen across Canada, with a focus on the clinical inclusion criteria to the programs.MethodsThe authors searched the terms of reference of the 10 Canadian provinces and three territories, focusing on general eligibility criteria for home oxygen (including blood gas criteria, and eligibility criteria for ambulatory and nocturnal oxygen), and compared the eligibility criteria to the widely accepted criteria of the Nocturnal Oxygen Therapy Trial (NOTT) trial, the clinical recommendations of the Canadian Thoracic Society and the results of Cochrane reviews.ResultsThe terms of reference for nine provinces were retrieved. All jurisdictions have similar criteria for long-term oxygen therapy, with slight differences in the thresholds of prescription and the clinical criteria defining 'pulmonary hypertension' or 'cor pulmonale'. The use of oxyhemoglobin saturation as a criterion for funding is inconsistent. All nine provinces fund nocturnal oxygen, all with different clinical criteria. Funding for portable oxygen widely varies across provinces, whether the ambulatory equipment is offered to patients on long-term oxygen therapy or to those who have isolated exercise-induced desaturation. The terms of reimbursement are very heterogeneous.ConclusionsHeterogeneity exists in the criteria for eligibility to home oxygen programs and funding across Canada. Terms of prescription and reimbursement of oxygen are not necessarily supported by available evidence from the current literature in several Canadian jurisdictions.
| S-EPMC4676395 | biostudies-literature
Project description:BackgroundState policies to optimize prescriber use of Prescription Drug Monitoring Programs (PDMPs) have proliferated in recent years. Prominent policies include comprehensive mandates for prescriber use of PDMP, laws allowing delegation of PDMP access to office staff, and interstate PDMP data sharing. Evidence is limited regarding the effects of these policies on adverse opioid-related hospital events.ObjectiveThe objective of this study was to assess the effects of 3 PDMP policies on adverse opioid-related hospital events among patients with prescription opioid use.Research designWe examined 2011-2015 data from a large national commercial insurance database of privately insured and Medicare Advantage patients from 28 states with fully operating PDMPs by the end of 2010. We used a difference-in-differences framework to assess the probabilities of opioid-related hospital events and association with the implementation of PDMP policies. The analysis was conducted for adult patients with any prescription opioid use, a subsample of patients with long-term prescription opioid use, and stratified by older (65+) versus younger patients.ResultsComprehensive use mandates were associated with a relative reduction in the probability of opioid-related hospital events by 28% among patients with any opioid and 21% among patients with long-term opioid use. Such reduction was greater (in relative terms) among older patients despite the lower rate of these events among older than younger patients. Delegate laws and interstate data sharing were associated with limited change in the outcome.ConclusionComprehensive PDMP use mandates were associated with meaningful reductions in opioid-related hospital events among privately insured and Medicare Advantage adults with prescription opioid use.
| S-EPMC7985821 | biostudies-literature
Project description:BackgroundPrescription drug monitoring programs (PDMPs) that collect and distribute information on dispensed controlled substances have been adopted by nearly all US states. We know little about program characteristics that modify PDMP impact on prescription opioid (PO) overdose deaths.MethodsWe measured associations between adoption of any PDMP and changes in fatal PO overdoses in 2002-2016 across 3109 counties in 49 states and D.C. We then measured changes related to the adoption of "proactive PDMPs," which report outlying prescribing/dispensing patterns and provide broader access to PDMP data by law enforcement. Comparisons were made within 3 time intervals that broadly represent the evolution of PDMPs (2002-2004, 2005-2009, and 2010-2016). We modeled overdoses using Bayesian space-time models.ResultsAdoption of electronic PDMP access was associated with 9% lower rates of fatal PO overdoses after three years (rate ratio [RR] = 0.91, 95% credible interval [CI]: 0.88-0.93) with well-supported effects for methadone (RR = 0.86,95% CI: 0.82-0.90) and other synthetic opioids (RR = 0.82, 95% CI: 0.77-0.86). Compared with states with no/weak PDMPs, proactive PDMPs were associated with fewer deaths attributed to natural/semi-synthetic opioids (2002-2004: RR = 0.72 [0.66-0.78]; 2005-2009: RR = 0.93 [0.90-0.97]; 2010-2016: 0.89 [0.86-0.92]) and methadone (2002-2004: RR = 0.77 [0.69-0.85]; 2010-2016: RR = 0.90 [0.86-0.94]). Unintended effects were observed for synthetic opioids other than methadone (2005-2009: RR = 1.29 [1.21-1.38]; 2010-2016: RR = 1.22 [1.16-1.29]).ConclusionsState adoption of PDMPs was associated with fewer PO deaths overall while proactive PDMPs alone were associated with fewer deaths related to natural/semisynthetic opioids and methadone, the specific targets of these programs. See video abstract at, http://links.lww.com/EDE/B619.
| S-EPMC7027962 | biostudies-literature
Project description:Systemic lupus erythematosus (SLE) has one of the highest hospital readmission rates among chronic conditions. This study was undertaken to identify patient-level, hospital-level, and geographic predictors of 30-day hospital readmissions associated with SLE.Using hospital discharge databases from 5 geographically dispersed states, we studied all-cause readmission of SLE patients between 2008 and 2009. We evaluated each hospitalization as a possible index event leading up to a readmission, our primary outcome. We accounted for clustering of hospitalizations within patients and within hospitals and adjusted for hospital case mix. Using multilevel mixed-effects logistic regression, we examined factors associated with 30-day readmission and calculated risk-standardized hospital-level and state-level readmission rates.We examined 55,936 hospitalizations among 31,903 patients with SLE. Of these hospitalizations, 9,244 (16.5%) resulted in readmission within 30 days. In adjusted analyses, age was inversely related to risk of readmission. African American and Hispanic patients were more likely to be readmitted than white patients, as were those with Medicare or Medicaid insurance (versus private insurance). Several clinical characteristics of lupus, including nephritis, serositis, and thrombocytopenia, were associated with readmission. Readmission rates varied significantly between hospitals after accounting for patient-level clustering and hospital case mix. We also found geographic variation, with risk-adjusted readmission rates lower in New York and higher in Florida as compared to California.We found that ~1 in 6 hospitalized patients with SLE were readmitted within 30 days of discharge, with higher rates among historically underserved populations. Significant geographic and hospital-level variation in risk-adjusted readmission rates suggests potential for quality improvement.
| S-EPMC4180780 | biostudies-literature
Project description:Objectives: This study explores the heterogeneity in effects of the 2014 Affordable Care Act (ACA) Medicaid expansions on insurance coverage, health care access, and health status of low-income women with dependent children by pre-expansion state-level income eligibility. Materials and Methods: We employ a quasiexperimental difference-in-differences design comparing outcome changes in Medicaid expansion states to nonexpansion states. We estimate effects separately for three groups of expansion states based on pre-expansion (2013) parent income eligibility: low pre-expansion eligibility (<90% of federal poverty level [FPL]), high eligibility (90% to <138% FPL), and full eligibility (≥138% FPL). Study samples include women with dependent children below 138% FPL from the 2011 to 2018 American Community Survey for the insurance outcomes, and from the 2011 to 2018 Behavioral Risk Surveillance System for the access and health outcomes. Results: There is stark heterogeneity in changes of health insurance and health care access by pre-expansion income eligibility levels. In comparison to Medicaid non-expansion states, there are large increases in insured rate (9 percentage-points) and Medicaid coverage (16 percentage-points) in expansion states with low pre-expansion eligibility. Insurance changes are much smaller in states with high or full pre-expansion eligibility. Changes in access largely mirror those in coverage. There are no significant changes in health status regardless of pre-expansion eligibility. Conclusions: The ACA Medicaid expansions increased coverage and access for low-income women with dependent children primarily in states with low pre-expansion parent eligibility, and therefore, reduced differences in these outcomes between expansion states.
| S-EPMC8558059 | biostudies-literature
Project description:ImportanceAlthough independent charity patient assistance programs improve patient access to costly prescription drugs, recent federal investigations have raised questions about their potential to increase pharmaceutical spending and to violate the federal Anti-Kickback Statute. Little is known about the design of the programs, patient eligibility, or drug coverage.ObjectiveTo examine the eligibility criteria of the independent charity patient assistance programs and the drugs covered by them.Design, setting, and participantsDescriptive cross-sectional study of the 6 largest independent charities offering patient assistance programs for patients including, but not limited to, Medicare beneficiaries in 2018. These charities offered 274 different disease-specific patient assistance programs. Drugs were identified for subgroup analysis that had any use reported on the Medicare Part D spending dashboard and any off-patent brand-name drugs that incurred more than $10 000 in Medicare spending per beneficiary in 2016.ExposuresSupport by independent charity patient assistance programs.Main outcomes and measuresThe primary outcomes were the characteristics of patient assistance programs, including assistance type, insurance coverage (vs uninsured), and income eligibility. The secondary outcomes were the cost of the drugs covered by the patient assistance programs and the coverage of expensive off-patent brand-name drugs vs substitutable generic drugs.ResultsAmong the 6 independent charity foundations included in the analysis, their total revenue in 2017 ranged from $24 million to $532 million, and expenditures on patient assistance programs ranged from $24 million to $353 million, representing on average, 86% of their revenue. Of the 274 patient assistance programs offered by these organizations, 168 (61%) provided only co-payment assistance, and the most common therapeutic area covered was cancer or cancer treatment-related symptoms (113 patient assistance programs; 41%). A total of 267 programs (97%) required insurance coverage as an eligibility criterion (ie, excluded uninsured patients). The most common income eligibility limit was 500% of the federal poverty level. The median annual cost of the drugs per beneficiary covered by the programs was $1157 (interquartile range, $247-$5609) compared with $367 (interquartile range, $100-$1500) for the noncovered drugs. Off-patent brand-name drugs (cost: >$10 000) were covered by a mean of 3.1 (SD, 2.0) patient assistance programs, whereas their generic equivalents were covered by a mean of 1.2 (SD, 1.0) patient assistance programs.Conclusions and relevanceIn 2018, among 274 patient assistance programs operated by the 6 independent charity foundations, the majority did not provide coverage for uninsured patients. Medications that were covered by the patient assistance programs were generally more expensive than those that were not covered.
| S-EPMC6686767 | biostudies-literature
Project description: Not available
| S-EPMC3703764 | biostudies-literature