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Express Lane Eligibility and Beyond: How Automated Enrollment Can Help Eligible Children Receive Medicaid and CHIP

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As states work to insure more children in challenging economic times, a new report funded by the Robert Wood Johnson Foundation (RWJF) explores how states can identify and enroll eligible but uninsured children by borrowing automated strategies that have proven effective in helping eligible people receive other public and private benefits. Authored by Urban Institute researcher Stan Dorn in collaboration with the National Academy for State Health Policy (NASHP), the report details how auto-enrollment strategies have the potential to identify, enroll and retain large numbers of eligible children while reducing state administrative costs. The report explains how the recently enacted Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) makes these strategies substantially easier for states to implement while establishing powerful new financial incentives for states to reach the greatest possible number of eligible children.
Express Lane Eligibility and Beyond: How Automated Enrollment Can Help Eligible Children Receive Medicaid and CHIP discusses CHIPRA’s new Express Lane Eligibility option, which lets states grant health coverage when information already in the hands of government agencies shows that children are eligible for Medicaid or the Children’s Health Insurance Program (CHIP).
The report finds:
• 89 percent of uninsured children who qualify for Medicaid and CHIP live in families who file income tax returns.
• 96 percent of children who receive free school lunches have family incomes low enough to qualify for Medicaid or CHIP.
• Only one-tenth of one percent of children who receive Food Stamps are ineligible for Medicaid and CHIP in states that take full advantage of CHIPRA.
 
 

Patient Safety and Medical Errors: A Road Map for State Action

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This report provides state executive and legislative branch officials with a framework for considering how they might coordinate with government and private stakeholders to address medical errors and patient safety in their states. The report outlines mechanisms to estimate the number of medical errors that occur and actions that states can take to improve patient safety in their various roles as purchasers, providers, regulators, educators, conveners, and policymakers.

patient_safety_roadmap.pdf 193 KB

 

State Patient Safety Centers: A New Approach to Promote Patient Safety

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As of 2004, six states (FL, MD, MA, NY, OR, PA) have enacted legislation supporting the creation of state patient safety centers to help address the problem of medical errors. This report examines the various models states have adopted in designing these centers and includes discussions of how the centers operate and monitor performance. The report also summarizes recommendations from center staff to other states that may be interested in following in their footsteps.

patient_safety_centers.pdf 354.8 KB

 

Improving Patient Safety: What States Can Do About Medical Errors

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This briefing paper synthesizes a discussion held among key policy officials in June 2000, at NASHP’s Flood Tide Forum II. The brief examines current federal, congressional, and state activities; proposes roles for states; and identifies actions that foundations and others could take.

Contents
Overview
Background
Patient Safety: How Significant a Problem for States?
What is happening at the Federal level and What Does that Mean for States?
Discussion
Next StepsCreate NASHP Publication | National Academy for State Health Policy Production Site

improving_patient_safety.pdf 598.8 KB

 

The Pennsylvania Learning Exchange: Helping States Improve and Integrate Patient Safety Initiatives Summary Report

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According to the Institute of Medicine (IOM), preventable medical errors are a leading cause of death in the United States. Yet, state officials who focus on patient safety have few venues to meet, share innovative strategies, and problem solve with each other because patient safety initiatives originate in a variety of state agencies.
This report summarizes the Pennsylvania Learning Exchange, an event that brought state officials to Pennsylvania in September 2007 to learn about the state’s successes, challenges, and key elements of its patient safety initiatives. The event was supported by the Commonwealth Fund.
Pennsylvania’s initiative is a model for developing a comprehensive, interagency approach to address patient safety within a broader context of state health policy and as a critical component of health reform. The Prescription for Pennsylvania coordinates patient safety efforts under an umbrella entity (the Governor’s Office of Health Care Reform) and involves multiple agencies. The learning exchange event focused on Pennsylvania’s innovative strategies, including its successful efforts to call statewide attention to the issue of patient safety; build a case for change; translate data into practice and policy; and create a state infrastructure to address the issue. It also provided an opportunity for visiting state officials to share their own innovations.
The purpose of the learning exchange was to enable state officials to explore policy and operational issues, identify emerging issues, develop policy solutions, and improve state health policy and practice.
Ten Pennsylvania patient safety officials from key state agencies were host officials. Participants included 24 state officials representing eleven states. All visiting officials provided short written summaries of what they gained from the learning exchange and how they planned to apply this new knowledge to their state’s work to improve patient safety.

Pennsylvania Learning Exchange Summary Report 448.2 KB

 

Statewide Patient Safety Coalitions: A Status Report

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In 12 states, providers, purchasers, consumers, and regulators have recognized the value of coordinating their efforts and have formed statewide public/private patient safety coalitions. These coalitions are educating health care professionals, purchasers, consumers, and policy makers about the nature of medical errors, the culture of safety, and strategies for reducing risks. The seven most mature coalitions are profiled in this report. Coalition members share lessons learned in membership development, communication, successful activities, and building trust.

patient_safety_coalitions.pdf 202.9 KB

Current State Programs Addressing Medical Errors: An Analysis of Mandatory Reporting and Other Initiatives

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Based on interviews with state and hospital officials, professional boards, providers, consumer representatives, and purchasers, this report places mandatory reporting within the context of current state and federal hospital oversight activity. It provides detailed information about how eight state-based mandatory hospital reporting programs came into existence, how these programs are operated, the associated legal issues, and other state-base initiatives aimed at improving patient safety.
Contents
Introduction
National Overview of the Hospital Oversight Environment: The Relationship Between State and Federal Efforts
Project Overview
Site-visit States’ Hospital Quality Oversight Policies and Practices
Background, Origins, and Evolution of Reporting Requirements
Nuts and Bolts of Reporting Requirements
Data Management and Integrity
Analysis and Use of the Data
Legal Protections for Reported Information
Other Patient Safety Activities and Initiatives
Findings
Conclusion
Appendix A: Mandatory Reporting Requirements for Hospital-based Adverse Events Maintained in State Agencies that License Hospitals
Appendix B: Expert Panel Membership
Appendix C: Summaries of Phone Interviews
Appendix D: Site-visit Protocols
Appendix E: State Reporting Requirements
Appendix F: New York State’s List of Events Requiring Root Cause Analysis
Appendix G: Stakeholder Initiatives
Appendix H: Patient Advocate Newsletter
Download this publication in sections:

medical_errors_analysis_secs1-4.pdf 1.2 MB
medical_errors_analysis_secs5-6.pdf 1002.7 KB
medical_errors_analysis_secs7-9.pdf 1.2 MB
medical_errors_analysis_secs10-12.pdf 1.1 MB
medical_errors_analysis_appenda_b.pdf 1 MB
medical_errors_analysis_appendc_d.pdf 628.2 KB
medical_errors_analysis_append_e.pdf 1.2 MB
medical_errors_analysis_appendf_g_h.pdf 1.4 MB

 

State-based Mandatory Reporting of Medical Errors: An Analysis of the Legal and Policy Issues

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This report explores data issues associated with mandatory reporting systems, potential interactions between mandatory reporting and malpractice litigation, the potential uses of publicly available mandatory reporting system data, and arguments for and against protections for such data.
 
Click here to download the zipped pdf file.
 

Cost Implications of State Medical Error Reporting Programs: A Briefing Paper

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This paper examines the costs of designing and implementing a state-based mandatory reporting system for adverse events that occur within hospitals.
The paper begins with a brief review of the Institute of Medicine’s study on medical errors and its recommendations regarding the role of states in addressing the issue. This is followed by a summary of existing state mandatory reporting programs as well as barriers perceived by states without reporting programs. A description of the two states whose programs were studied for this paper is then presented, including an analysis of how variations in program features impact cost.

cost_implications.pdf 143 KB

 

Defining Reportable Adverse Events: A Guide for States Tracking Medical Errors

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This report was developed to help policy makers develop, refine, and clarify mandatory reporting systems and potentially to compare their data nationally. The guide includes a comparison of the National Quality Forum’s (NQF) list of serious reportable events to existing state reporting systems and discusses further steps recommended by states to support the use and consistent implementation of the NQF list.

Defining Adverse Events 2003 698.7 KB

 

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