Use of utilization management methods in State Medicaid programs.
Buck, Jeffrey A
Date of Pub
Silverman, Herbert A
This article describes the use of utilization management (UM) methods by State Medicaid programs. The use of optional UM methods
range from zero in one State to eight in four States, with a median of five. A majority of States have programs for ambulatory
surgery, preadmission certification, lock-in, primary-care case management, and targeted case management. Overall, no UM method
was judged by States to have an adverse effect on access of quality of care. For UM methods mandated by the Medicaid program,
more than one-third of the States rated physician certification as minimally effective.
Ambulatory Surgical Procedures : Case Management : Certification : Health Care Surveys : Health Services Accessibility : Managed
Care Programs/organization & administration/standards/utilization : Medicaid/organization & administration/statistics & numerical
data/utilization : Physicians/standards : Quality of Health Care : State Health Plans/statistics & numerical data/utilization
: United States : Utilization Review/methods/statistics & numerical data