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Title: Evaluation of the Florida Medicaid MediPass program
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Title: Evaluation of the Florida Medicaid MediPass program
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Creator: Florida Center for Medicaid Issues, College of Health Professions, University of Florida
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Full Text











Evaluation of the Florida Medicaid

MediPass Program




January 2002




Agency for Health Care Administration








Prepared by:
Renee Dubault
Jennifer Petrella
Chris Loftis

Florida Center for Medicaid Issues
College of Health Professions
University of Florida










CONTENTS






Executive Summary .................................................... 3


Background ................................ ..................... 5


Operations and Program Administration .................................. 6
Network Management. ................ ......................... 6
Credentialing Procedures. ............... ................ . .. 8
Access and Availability to Specialists.................................. 9
Case Management..........................................11
Utilization Review ................. ............................. 12
Enhancements and Alternatives. ................................ 13
Organizational Structure and Functions. ................ ............ 14


Program Cost Analysis. ..................... ........................ 16


Summary of Recipient Survey Data. ................. ................. 20


Methodology ................ .................................. 21


References ................ .................................... 23


Appendices
Appendix A ................ .............................. 24
Appendix B ................ ................................ 26
Appendix C ................ ............................... 33
Appendix D ................ .............................. 34
Appendix E ................ ................................ 35









Executive Summary


Over the last decade, managed care arrangements have become the dominant
delivery system for providing health care services to Medicaid beneficiaries. There are
two main models of Medicaid managed care: 1) Managed Care Organizations (MCOs)
that contract with states to accept financial risk for provision of a comprehensive set of
services; and 2) Primary Care Case Management (PCCM) programs which are a non-
risk form of managed care usually involving the payment of a monthly fee to a contracted
provider for care coordination services in addition to fee for services payments for
medical services provided.1 The State of Florida uses both models of managed care to
provide services to its Medicaid population. MediPass is Florida Medicaid's PCCM
program. MediPass provides an alternative to MCOs in the areas of the state that are
served by participating managed care plans and serves as the only managed care
option in some of the rural areas of the state. The goal of the MediPass program is to
capitalize on the programmatic and cost saving strategies of managed care. Ideally,
MediPass, and PCCM programs in general, are designed to provide Medicaid recipients
with a "medical home" where they will receive appropriate and cost effective care by
avoiding inappropriate Emergency Room (ER) visits and reducing the need for hospital
admissions.
This evaluation examined the operational procedures and administration of the
MediPass program, as well as an analysis of costs and recipient satisfaction. Overall,
we found that the MediPass program achieves its goal of providing Medicaid recipients
with appropriate medical care and simultaneously curbing inappropriate and over-
utilization of services. The cost analysis of medical claims data for FY 98-00 shows that
the MediPass population actually consumes fewer resources than would be statistically
expected based on statewide Medicaid resource use while controlling for age, gender,
and morbidity. The program achieves greater savings for the Temporary Assistance to
Needy Families (TANF) eligibility category than for the Supplemental Security Income
(SSI) eligibility category. The cost savings are particularly pronounced in the inpatient
hospitalization service category across both eligibility categories, leading one to
conclude that access to proper primary care results in fewer hospital admissions.
While the MediPass program is succeeding at controlling costs and utilization,
this has not resulted in dissatisfaction on the part of program enrollees. Survey results
from the Consumer Assessment of Health Plans (CAHPs) conducted in Dade and
Broward counties indicate that MediPass enrollees report a high level of satisfaction with
program interactions. This survey was conducted on enrollees in the MediPass
program, the Provider Service Network (PSN) pilot project as well as all of the Health
Maintenance Organizations (HMOs) serving the Medicaid population in that area of the
state. The results of the surveys indicate that enrollees in all of these programs are
generally satisfied, with the MediPass program receiving modestly higher levels of
satisfaction than either the PSN or HMOs.
The analysis of operating procedures and program administration focused on
several key functional areas: network management, credentialing, access and
availability of specialists, case management, utilization review, program enhancements

SMedicaidManaged Care: A Guide for States, Fifth Edition, by Neva Kaye, May 2001, National Academy
for State Health Policy, Funded by the Henry J. Kaiser Family Foundation, The Health Resources and
Services Administration, The David and Lucile Packard Foundation, and the Congressional Research
Service.









and alternatives to managed care, and organizational structure and functions. In this
analysis, it is noted that the MediPass program has well-developed policies in almost all
relevant areas. However, additional policies similar to those commonly used by
Managed Care Organizations could be implemented that would allow the program to
achieve administrative cost savings, as well as greater control over providers and
utilization patterns. Among the strategies identified are:
Limitation of the size of the MediPass primary care provider (PCP)
network through implementation of policies that require participating
providers to accept at least a minimum number of recipients
Elimination of duplicate verification of credentials by accepting verification
by other accredited plans
Implementation of policies that require Medicaid enrolled specialists to
accept MediPass patients
Implementation of enhanced utilization review procedures to hold
providers accountable for practice patterns
These strategies could result in improved management and cost savings for the
MediPass program.
Overall, the MediPass program has achieved its programmatic goals of reducing
healthcare costs and inappropriate utilization of services while also providing high quality
care for Medicaid recipients.









Background


The MediPass program is a primary care case management (PCCM) program
developed by Florida Medicaid in 1991 for the purpose of securing access for Medicaid
recipients to adequate primary care, decreasing inappropriate utilization, and controlling
program costs for individuals receiving services. Medicaid eligible persons either select
or are assigned to a Primary Care Provider (PCP). The PCP is currently paid a fee of
$3.00 per month per enrolled person to manage and coordinate the enrollee's care in
addition to the customary reimbursement for Medicaid services. The goal of the
MediPass program was to incorporate some of the advantages of managed care into
Medicaid program administration by providing access to high quality care, ensuring that
clients receive appropriate care in the proper setting, and fostering development of
strong doctor-patient relationships.
As of August 2001, the MediPass population represents over 630,000 of the
more than 1.5 million Florida Medicaid recipients. MediPass became available statewide
in 1996 after initial implementation in the counties of Hillsborough, Manatee, Pasco, and
Pinellas in 1991. Florida statutes currently mandate individuals in specific Medicaid
eligibility categories, Temporary Assistance to Needy Families (TANF) and
Supplemental Security Income (SSI) without Medicare, to enroll in managed care;
individuals dually eligible for Medicaid and Medicare are not included in these eligibility
categories. All eligible Medicaid enrollees now participate in either MediPass or in a
health maintenance organization (HMO). Enrollees who did not choose either MediPass
or an HMO were assigned using a formula designed to balance the number of enrollees
between these programs. MediPass now covers more persons than initially enrolled in
1991 when it covered only persons eligible for benefits under Aid to Families with
Dependent Children (AFDC). Currently, MediPass covers individuals eligible for
Supplemental Security Income, the Work and Gain Economic Self-Sufficiency program
(WAGES), and various "specialty coverages" established by the state legislature (e.g.,
refugee, Medications-only, foster care, and subsidized adoption populations).
A previous evaluation completed by Florida State University in 1998 assessed
enrollee and provider satisfaction with the MediPass program and evaluated the cost
and service use of MediPass enrollees compared to those covered under fee for service
plans. This evaluation concluded that MediPass resulted in cost savings for AFDC and
SSI enrollees but not for smaller groups of enrollees in the program. Cost savings were
observed in all areas except pharmaceuticals. Finally, MediPass enrollees and providers
reported satisfaction with the MediPass case management services.
With double-digit increases in Medicaid costs and increasingly tighter budget
conditions, the Florida Legislature and the Agency for Health Care Administration
(AHCA) are continuing to explore ways to increase efficiency of the Medicaid program.
Legislators have proposed several amendments to Florida Statutes that would eliminate
the requirement for AHCA to provide choice counseling to Medicaid recipients and to
limit enrollment in MediPass to those counties that have fewer than two HMO choices.
AHCA has contracted with the Florida Center for Medicaid Issues to perform an
independent evaluation of whether the MediPass program is successful in obtaining
programmatic and cost benefits of managed care while also maintaining the MediPass
option. This evaluation will provide a review of the organizational structure and
operational procedures of the program. In addition, this report will provide analyses of
health care utilization and costs, patient satisfaction, cost control measures, improved









management of the MediPass primary care physician network, improved access to
primary and specialty care, and development and implementation of alternative
managed care arrangements.



Operations and Program Administration


The following sections address the various areas of MediPass program
administration. Each section discusses the current operating procedures for the specific
program functions as well as common practices used by other entities performing these
types of functions. The specific program areas addressed are: network management,
credentialing, access to specialists, case management, utilization review, program
enhancements and alternative programs, and organizational structure and staffing.


Network Management


The concept of network management represents the efforts of managed health
plans' to exert greater control over health care providers in order to reduce unnecessary
utilization and costs. Health plans contract with a limited number of providers to supply
the primary and specialty care of their members. In essence, the providers agree to
specific conditions and restrictions stipulated by the health plans with the goal of
monitoring physician practice patterns and eliminating unnecessary and costly care in
exchange for a higher volume of patients from the plan. Health plans generally
implement strict monitoring of the care provided to its members to ensure that the
contracted providers are following clinical and organizational guidelines.
The National Committee for Quality Assurance (NCQA) is charged with
developing guidelines and awarding accreditation to managed health care organizations.
Under NCQA guidelines, a health plan receives "full" credit for its network management
by establishing clear standards for the number and geographic distribution of providers,
specifically primary care providers.2 Although NCQA does not set a numerical standard,
it is expected that health plans do this to ensure appropriate network management.
In order to keep costs down, health plans must balance the competing goals of
keeping their PCP network small enough to exert control over providers, large enough to
provide adequate capacity and choice for their members, and flexible enough to adapt to
increases and/or decreases in enrollment. Health plans generally recognize that very
large networks that offer the maximum amount of choice are less efficient and lack many
of the management features associated with a managed care delivery system.
For the purposes of network management, the MediPass program has a policy of
accepting all Medicaid PCPs who apply and are approved through the credentialing
process. As a result, the MediPass PCP network is enormous, with 4,685 contracted
providers and/or groups statewide and has a capacity that is 10 times greater than the


2 Surveyor Guidelines for the Accreditation oj UlCOs, National Committee for Quality Assurance, effective
July 1, 2001.










enrolled MediPass population. Table 1 illustrates the size and capacity of the MediPass
network.





MediPass Network Capacity by Area


#of PCPslGroups #of PCPslGroups
Total Total PCP Available Average # of Total # of with < 50 with < 100
MediPass Requested Excess Slots Patients per Contracted Requested Requested
Area Enrollees Capacity Capacity per Enrollee PCPIGroup PCPslGroups Capacity Capacity
Area 1 35,346 127,601 92,255 4 176 201 41 90
Area 2 46,108 351,595 305,487 8 184 250 13 25
Area 3 80,444 448,757 368,313 6 222 362 54 71
Area 4 62,497 457,725 395,228 7 179 349 41 56
Area 5 35,385 413,281 377,896 12 96 369 70 93
Area 6 61,878 581,987 520,109 9 137 451 43 66
Area 7 58,240 454,014 395,774 8 125 467 82 121
Area 8 38,572 326,012 287,440 8 142 272 51 65
Area 9 54,212 409,665 355,453 8 186 291 12 18
Area 10 33,756 623,139 589,383 18 80 424 30 52
Area 11 128,527 1,839,283 1,710,756 14 103 1,249 22 55
Total 634,965 6,033,059 5,398,094 10 136 4,685 459 712


Appendix A contains the network capacity and distribution by county, providing
more detail than the above table on which counties have the greatest excess capacity. It
is clear that the smaller and more rural counties have considerably less excess capacity
and fewer contracted providers than the more metropolitan areas of the state. Although
it is difficult to quantify exactly how much excess capacity is too much or what
constitutes adequate provider choice for recipients, reasonable standards could be
developed. Employer groups generally specify a required provider to patient ratio when
contracting with health plans for employee health benefits. A standard ratio of providers
to MediPass recipients along with some type of geographical distribution requirement
could be developed to limit the size of the MediPass network. For example, the state of
Texas requires that provider networks for its Medicaid PCCM and HMO programs
maintain a "geographic distribution such that no client has to travel more than 30 miles to
access a PCP."3 This is similar to the MediPass program's requirement that a PCP must
be available within 30 minutes of travel time. However, the MediPass program could
implement additional standards that set specific PCP to member ratios that would limit
the size of the PCP network. Under these types of limitations, the network could be
closed by not accepting new PCPs into the MediPass network unless the standards
were not being met, either because of increased enrollment or because of provider
attrition.
In addition to patient to provider ratios and geographic distribution requirements,
MediPass could also implement a minimum standard capacity, not allowing providers to
set their requested patient capacity below a set minimum. As part of their contractual


3 MedicaidManaged Care Review-Final Version, Texas Health and Human Services Commission,
November 1, 2000.









agreements, most health plans require PCPs to continue accepting new patients from
the plan until their panel meets a minimum threshold. The MediPass program currently
allows its participating PCPs to set any maximum threshold for the number of members
they will accept. There are even participating PCPs who have their cap set as low as
one patient. As a result, approximately 10 percent of the contracted providers and/or
groups statewide set their cap on members at a threshold of 50 or less and 15 percent of
providers/groups statewide set their cap at a threshold of 100 or less. Table 1 provides
a listing of the total number of providers/groups in each area with caps of 50 and 100
patients or less. Some of these providers with very low caps could be specialists that
provide care to special needs populations like Children's Medical Services (CMS)
members that could be exempted from the minimum standards. However, for PCPs
serving the general MediPass population, it is costly for the program to maintain these
providers in terms of credentialing, training and monitoring with very little return to the
program because of their unwillingness to accept more than a minimal number of
MediPass patients. The MediPass program could institute a policy that would terminate
providers that are unwilling to accept at least a minimum number of program enrollees.
Implementation of a policy to limit the size of the MediPass provider network would
require approval from federal authorities at the Center for Medicare and Medicaid
Services.


Credentialing Procedures

A vital component of network management includes assuring that the quality of
network providers is continually evaluated. Such levels of "quality" are often defined
and assessed via a plan or network's credentialing and re-credentialing procedures.
MediPass has a comprehensive, well-defined set of credentialing policies and
procedures in place to assure that its providers meet high quality standards.
The current MediPass enrollment credentialing procedures are in line with
industry standards as defined by NCQA. Initial site visits are done by local offices in an
appropriate time frame and credentials are verified using NCQA approved sources.
Upon completion of site visit and primary source verification, providers are assigned to
one of five categories. The current policy identifies three of the five categories of
applicants as eligible for presentation to a credentialing committee for final enrollment
approval. The remaining two categories represent providers who are denied eligibility
for enrollment in MediPass.
While the current MediPass credentialing policies meet the NCQA guidelines,
there are some notable differences. NCQA does not quantify the acceptable or
unacceptable number of paid malpractice claims to determine enrollment eligibility. The
NCQA guideline simply states that this information must be reviewed prior to enrollment
approval. The current MediPass credentialing policy, provided in Appendix B, clearly
identifies that "providers who have paid three or more malpractice claims within the past
five years based on the date of act/omission," will be denied enrollment. Secondly,
NCQA guidelines require that network providers be re-credentialed every three years as
opposed to the current MediPass re-credentialing guidelines of every two years. NCQA
also requires an evaluation of member complaints and reviews of under- and over-
utilization during the re-credentialing process. The current MediPass policy states that
the provider file, including member complaints and utilization review reports, should be
forwarded to headquarters at the time of re-credentialing. However, interviews with









local area office personnel reveal that files are not routinely requested in the re-
credentialing process.
The above differences reveal the subtle, more stringent standards for
credentialing required by MediPass, relative to NCQA guidelines. The absolute criteria
of denying applicants with three or more paid malpractice claims is addressed differently
by NCQA accredited health plans. Although NCQA guidelines do not give explicit
numbers, NCQA accredited health plans do look at paid malpractice claims, and do
consider this in their application process. There is a high probability that an applicant to
these networks would be denied enrollment with at least three paid malpractice claims in
a 5-year span. Thus, in reality, MediPass credentialing has virtually the same standards
as those of NCQA accredited health plans.
However, there is one practice followed by numerous health plans that is not
used by the MediPass program in its initial credentialing of providers. Many NCQA
accredited health plans delegate their primary source verification by accepting letters of
approval from other NCQA fully accredited health plans. At the Florida Primary Care
Case Management Workshop (November 2001) it was identified that ACS, the current
contractor for network management and credentialing for Texas' PCCM program,
currently delegates this component of their credentialing process as well. This
delegation eliminates duplication of primary source verification. Although this delegated
process is provided for in the MediPass credentialing policies (Appendix B) as an option
for re-credentialing of existing MediPass PCPs, the MediPass provider enrollment form
or checklist does not offer the option to provide an approval or reappointment letter to
serve in lieu of primary source "duplicate" verification. Thus, providers entering the
process are not aware of this option. This primary source verification is time intensive
for MediPass staff, especially in light of the current size of the MediPass network.
If the option to waive initial credentials verification based on a provider's
enrollment in an approved NCQA accredited plan was more widely implemented, the
MediPass credentialing process could be streamlined. This would eliminate duplicate
verification, which would decrease administrative costs, resources, and the time required
for a provider to become credentialed. This policy change would not result in
compromised quality. This has been confirmed with the Texas PCCM program, which
has already implemented this practice.

Access and Availability to Specialists

Access and availability of certain specialists, is one of the most pressing
problems in the MediPass program. The problem is not unique to the MediPass
program, but is a problem throughout Florida Medicaid. Medicaid area offices identify
this as one of the top complaints they encounter. Ostensibly, MediPass enrollees have
access to all specialists enrolled as providers in the Florida Medicaid program; however,
this does not match the reality faced by program participants. In reality, in the private
office setting, a Medicaid enrolled specialist has the ability to accept as many or as few
referrals of Medicaid or MediPass patients as he or she chooses. Many specialists
simply choose not to accept referrals of these patients when they are not presented in
an emergency setting that requires them to accept the patient.









Interviews with specialists as well as prior published studies reveal that the
primary cause of this limited access and availability is physician reimbursement rates.4
Currently reimbursement rates average 57 percent of the Medicare fee schedule. These
rates are significantly lower than those found in state PCCM programs that do not have
limited access to specialists. An expert with the North Carolina Access program
reported that specialist access in their PCCM program is not a problem because
reimbursement rates are comparable to Medicare. Specialists frequently have increased
overhead costs relative to PCPs. These include capital costs as well as significantly
higher liability insurance. Many specialist providers claim that they lose money when
they see a Medicaid or MediPass patient.
In a previous survey conducted by AHCA of dermatologists and orthopedic
surgeons, those that do enroll as Medicaid providers indicate that their motivation is civic
duty and contribution to the community, not financial gain.4 In today's atmosphere of
decreased physician reimbursement rates throughout the medical profession, fewer
providers are willing to provide services with reimbursement rates that do not at least
cover their basic overhead costs.
Although MediPass recipients report few problems in getting referrals to
specialists when they perceived they needed one, getting a referral does not ensure
getting an appointment. In an analysis of Medicaid beneficiary access to physician
specialists compared to projected provider need, 14 out of 24 specialty areas were lower
than the lowest estimate of need based on population.4 Of the remaining 10 specialties
where access was greater than the lowest estimate, 4 of those specialties were hospital
based physician specialists (Radiologists, Anesthesiologists, Pathologists and
Emergency Medicine).4 It is often through ER visits and hospital admissions that
specialty access is granted. Anecdotal evidence suggests that many specialty providers
enroll in Medicaid to assure that they will be reimbursed when "obligated" to see
Medicaid recipients in these hospital settings. However, if an ailment is stabilized by an
ER provider who recommends follow up care with a particular specialist, the on-call
physician often denies follow-up in his or her office setting claiming that they do not
accept Medicaid (MediPass) patients.
Currently, MediPass has no standards in place to assure availability or access of
specialty care practitioners. NCQA requires accredited health plans to have quantifiable
and measurable standards for specialty care access.2 Standards such as determining
an acceptable ratio of members to specialty access or using zip code analysis are
acceptable measures. In conjunction with access standards, health plans, including
Medicaid HMOs, define acceptable time frames (availability) for which a specialist must
see a patient with a type of symptom, i.e., within two weeks for non-urgent cases. These
time frames are monitored by patient complaints and enforced via contractual
agreement.
MediPass and Medicaid do not require physician accountability for availability. If
guidelines were established to assure specialist access, this would still not resolve the
issue of availability. Implementing a minimum requirement of non-emergent visits for
specialists will deter providers who are not willing to see Medicaid patients outside of the
ER setting from enrolling as Medicaid providers. If a specialist were required to see, for
example, a minimum of six non-emergent Medicaid patients a month, a provider would
need to decide if it was in his or her best interest to see ER and hospital patients pro-
bono or agree to see a limited number Medicaid/MediPass office visits per month.


4 Access to Medicaid Physician Specialists, Agencyfor Health Care Administration, November 2000.









Implementing such a policy would result in one of two things: a cost savings for the
Medicaid program for ER visits by specialists only credentialed for this reason or a more
equitable distribution of the financial burden to specialists who do participate in
Medicaid.


Case Management


Providers who enroll as PCPs in the MediPass program are required to sign an
Agreement for Participation in MediPass that stipulates the case management functions
required of the providers. In general, the agreement states that participating providers
must "provide primary care services; make referrals for specialty care when medically
necessary and appropriate; follow the results of referrals and maintain overall
responsibility for the health care of recipients even while under the care of a specialist;
maintain a comprehensive medical record which documents the continuum of care
provided; adhere to quality-of-care standards established for MediPass; and cooperate
to the greatest extent possible with disease management organizations." More
specifically, in carrying out the above listed duties, MediPass PCPs are required to
contact all newly enrolled members at least twice to attempt to arrange for an initial
preventive health screening and follow-up preventive screenings based on a set
schedule, attempt to obtain medical records from any known previous PCPs and
maintain the patient record to MediPass standards, and provide 24-hour coverage to
provide consultation, triage, and, if necessary, approval of emergency room usage or
specialty referral. In exchange for these and other case management services,
MediPass PCPs receive $3 per enrolled member per month (pm/pm). Some discussion
of reducing the case management fee to $2 pm/pm has taken place in recent years.
This reduction could result in some providers deciding not to continue participation in the
program.
The MediPass program provides training to all newly enrolled PCPs to explain
these policies and requirements. However, it is not required that the providers attend
these training sessions. It is only necessary that the enrolled provider send a
representative from his or her staff to attend the training. Because of this lack of direct
contact with providers, some PCPs do not fully understand their case management
responsibilities, especially in regard to newer program functions. For example, area
offices report that PCPs are confused about the role of the Disease Management
Organizations (DMO) and are suspicious of interference with the care of their patients.
This lack of understanding may hamper the effectiveness of the DMOs to provide
services to their clients. In addition to confusion about some of the functions, PCPs are
often unable to fulfill other case management obligations. For example, although it is
required that PCPs attempt to contact patients regarding preventive visits, they often find
that reliable phone numbers and/or addresses cannot be obtained. If providers are
unable to contact assigned members, it is unreasonable to expect the PCPs to provide
the level and frequency of preventive care set forth by the program.
The MediPass program provides PCPs with information regarding its
expectations for primary care case management through its printed materials (provider
agreement, policies and procedures) and training programs. However, participating
providers do not always read the fine print and understand all of the requirements or are
unable to make serious efforts at compliance because of data limitations. In order to
alleviate some of these problems, the MediPass program could provide some on-site









(i.e., at physician offices) training for providers to ensure that PCPs truly understand
case management expectations and new program initiatives. This on-site training could
cover the basics of what is expected under their case management obligations. Under
this type of arrangement, providers could still send staff to the regular orientation
sessions to learn details about program administration, such as billing procedures that
the providers do not generally engage in.


Utilization Review


The functions of case management are designed to control the over-utilization of
medical services; specifically, to decrease or eliminate unnecessary hospital admissions,
emergency room visits, and visits to specialists. According to this model, the resulting
care to patients would be more cost effective because care would be provided in
appropriate settings and only when necessary. Utilization Review is a mechanism
developed by health plans to evaluate the practice patterns of the providers contracted
to supply care to its members. "Utilization review aims at assessing and affecting the
use of services and serves as a mechanism for quality assessment in the context of
inappropriate utilization."5 In conducting this process, health plans generally analyze
hospital admission rates, ER visits, and comparisons across individual or group
practices of specific procedures and diagnostic codes to assess compliance with
practice guidelines. Plans may also engage in more in-depth audits to assess the
appropriateness of hospital admissions or lengths of stay.
The MediPass program issues a Provider Utilization Summary report that is
mailed to participating PCPs. The report compares physicians and/or groups within a
specific geographic area against other physicians/group practices in the same practice
category (i.e., general and family practice, internal medicine, pediatrics). For example,
pediatricians in Escambia County are only compared to other pediatricians or pediatric
groups in that county. The Provider Utilization Summary (Appendix C) lists several
areas for comparison: office visits, ER visits, outpatient visits, physician referrals, lab
and x-ray procedures, therapy procedures, durable medical equipment, number of
MediPass patients and average cost per patient. This information is mailed to providers
with the aim of providing information to PCPs to allow self-comparisons with peers. The
MediPass program does not set explicit thresholds or benchmarks for PCPs to assess
their compliance with program guidelines. PCPs in the program report that these
summaries are difficult to understand and do not provide guidance on when or if they are
meeting or not meeting expected standards. In other cases, PCPs report that the
comparisons are not fair because some PCPs may care for MediPass patients that are
significantly "sicker" than those of other PCPs.
With these same issues to address, some other states' PCCM programs have
instituted a more complex physician profiling mechanism. For example, North Carolina
uses a physician profiling system that takes into account the age, gender, and morbidity
levels of patients in the practice being profiled as well as the patients in the comparison
group. Appendix D contains a sample PCP profile from North Carolina's Access
program.


5 Introduction to Health Services, 4 Edition, Edited by Stephen J. Williams, Sc.D., and PaulR. Torrens,
M.D., M.P.H., Delmar Publishers Inc. 1993, Albany, New York.









This type of physician profiling could improve the MediPass program's ability to
monitor the quality of care and utilization of resources provided by participating PCPs.
MediPass program officials could use it to identify utilization outliers, PCPs who either
allow unnecessary referrals or admissions, as well as PCPs who are under-serving their
enrolled members. This information could be used to enhance the program's efforts to
incorporate utilization review into the network management and re-credentialing
functions. The MediPass program is currently implementing procedures to flag providers
with excessive approval of ER visits that are deemed non-emergent and bring those
providers up for peer review. One of the problems with the mechanism being
implemented is that it does not account for the age, gender, and morbidity of the
patients, thus allowing for PCPs under review to claim that excessive or inappropriate
utilization is due to the illness levels of their patients. The physician profiling report
would be perceived by PCPs as a more readable, realistic, and fair mechanism.


Enhancements and Alternatives


The Agency for Health Care Administration (AHCA) is engaged in on-going
activities to improve heath care access and outcomes while also seeking ways to further
control Medicaid expenditures. In 1997, the Florida Legislature authorized the Agency to
contract with Exclusive Provider Organizations (EPOs) and Provider Service Networks
(PSNs) for the purpose of purchasing cost effective health care for Medicaid recipients.
These initiatives are aimed at producing alternative managed care arrangements that
reduce administrative costs, while providing high quality, appropriate care for Medicaid
recipients. The South Florida Community Care Network (SFCCN) is a PSN contracted
with the agency as a demonstration project and began operations on March 1, 2000.
The SFCCN was designed to capitalize on the principle that costs are better managed
when health care dollars are transferred directly from payer to provider, thus eliminating
additional costs from intermediate ("middle man") insurance and health care
organizations. The PSN demonstration project attempts to strengthen relationships
between AHCA and high-volume providers in order to take advantage of existing
managed care interventions, to increase coordination between Medicaid and local
indigent health care programs, to improve health outcomes and cost savings for clients,
and to enhance the quality of life for recipients with chronic health conditions. The
SFCCN is currently being evaluated for cost-effectiveness and patient satisfaction. In
addition to the PSN demonstration project, the Agency is issuing a Request for
Proposals (RFP) to contract with EPOs as another alternative to traditional managed
care. The EPOs would be licensed insurance providers with requirements similar to
traditional HMOs with some added flexibility in the regulations. The focus of these
contracting arrangements is to bring managed care to the counties that do not have
participating Medicaid HMOs and are currently only served by MediPass. These
organizations would provide additional options to Medicaid recipients required to enroll in
managed care. This would allow the Agency the advantage of providing care to
recipients on a pre-paid or fixed sum basis.
In addition to these projects, the Agency has also expanded the MediPass
program in 1997 to contract with disease management organizations (DMOs) to provide
disease management services for enrolled recipients living with diabetes, HIV/AIDS,
asthma, and hemophilia. DMOs are private companies that specialize in disease
management for the purpose of reducing costs and improving health care outcomes for
patients with chronic illnesses. They offer an integrated approach to the treatment of









chronic illness by coordinating support and provision of services among patients and
physicians. The Legislature expanded Florida's disease management initiative in 1998 to
include patients with hypertension, cancer, end stage renal disease, and sickle cell
anemia. Eligible recipients are automatically enrolled in the disease management
program, but may cancel enrollment at any time. Six percent of the MediPass population
meets the criteria for the diseases that the Agency currently manages. This initiative is
still in development and is currently being evaluated to determine its effectiveness in
reducing costs and improving health outcomes.
Another pilot project, the MediPass Pilot Projects/Pediatrics ER Diversion
Projects, is aimed at improving primary care case management and preventative
services for pediatric enrollees of the MediPass program. AHCA intends to capitalize on
existing physician-patients relationships and services provided through managed care
organizations, while incorporating mechanisms designed to improve access, control
costs, and improve health outcomes. AHCA would also like to aid the development of
minority-physician networks through this program. Providers are responsible for
providing or coordinating referrals for Child Health Check-ups (EPSDT), specialty health
care services, dental care, and Healthy Start services for infants under age 12 months.
Service providers must also arrange for coverage of services, consultation, and approval
of services 24 hours per day, seven days a week. Eligible enrollees are recipients of the
Work and Gain Economic Self-Sufficiency (WAGES) programs, created in 1997 to
replace the AFDC program after it was revised through the federal welfare legislation in
1996; individuals receiving AFDC-related Medicaid Assistance Only; Sixth Omnibus
Budget Reconciliation Act (SOBRA) children; individuals receiving Supplemental
Security Income (SSI) without Medicare coverage; and children in foster care or
subsidized adoption arrangements.
The above projects are examples of the Agency's continuing efforts to design
and implement programs that enhance the provision of health services and improve the
health outcomes of Medicaid patients. Over the past several years, AHCA has initiated
several managed care and disease management programs aimed at improving access,
strengthening patient-physician relationships, controlling costs, and improving heath
care outcomes.


Organizational Structure and Functions

An organization's structure and functional division of labor often determine
success or failure regardless of the quality of staff or written policies and procedures. If
an organization is poorly structured, success in one department may actually cause
difficulties in another. The MediPass program employs intelligent and capable staff and
has developed clear and thorough policies and procedures. However, despite these
assets, the nature of the MediPass organizational structure lends itself to fragmentation
that often results in a duplication of effort.
Duplication of effort was most apparent in the tracking and maintenance of
provider data. The Agency's headquarter staff maintains databases of PCP provider
data elements as well as do many area offices. Each area office interviewed had
created their own PCP provider information databases and maintained their own set of
pertinent fields. This redundancy is not only duplication but may also add to
discrepancies in data. Currently, no procedure exists to assure the changes in area
office databases are communicated to headquarters. In conjunction, area offices









maintain lists of specialty providers who are actually willing to see MediPass patients as
directories for their PCPs. These directories seemed essential to all area offices and
their PCPs and might be more efficiently managed if a centralized database could hold
this information for all areas of the state.
Both the headquarters as well as area offices produce training materials and
newsletters. Local offices admit that in light of recent staffing cuts, these initiatives are
the first to be sacrificed for more pressing job responsibilities. Area offices contend that
provider bulletins on Explanation of Benefits (EOB) forms sent to PCPs do not provide
for an effective communication format. These EOBs are rarely seen by the providers
and are dependant on office staff educating their providers. It is apparent via their
production of newsletters that area offices have issues that require heightened provider
awareness. These area offices interact often with one another to resolve issues and
obtain advice on difficult issues. If area issues were centrally communicated to
headquarters, perhaps a publication containing area-specific issues could be produced
or added to the existing Medicaid Bulletin.
These examples are representative of duplication as well as fragmentation of
duties between headquarters and area offices. These problems are further evidenced
by area offices being unclear about the intricacies of some policies. For example, area
offices all communicated a lack of clarity in the role they play in the credentialing
process. This lack of clarity exists despite a well-defined and comprehensive
credentialing policy written by headquarters. The tracking of complaints represents
another area of fragmentation. Both area offices and headquarters receive complaints
from providers and members but no central database is used to capture these issues
despite a credentialing policy component to review such complaints upon re-
credentialing.
In the process of conducting this evaluation, it became obvious that although
policies were understood and thought effective by headquarters' staff, area office staff
were often less clear about their roles within the same policies. Existing policies often
fail to predict the unique situations that arise in the field. Under the current policies, area
office staff lacks the authority to deviate from policies to address repeated problems.
For example, headquarters has a policy that termination letters must be received from
providers when disenrolling from the MediPass program. Even if many attempts to
obtain such a letter are unsuccessful and verbal communication has been provided to
headquarters and the area office, PCPs continue to appear as active providers in the
MediPass program. Area office personnel have no authority to make the changes that
would assist the program in maintaining the most accurate information regarding
program participation, phone number changes, and address changes. Strict
implementation of these types of policies results in difficulties for area offices that must
continually maintain provider files on PCPs that have left the program and separate
databases containing correct contact information. Uniform databases need to be
created to meet the needs of both headquarters and area offices. Area offices should
be empowered to update these central or networked databases since they are the front
line where information is most likely to be communicated.
Improved coordination and communication between the Agency's headquarter
staff and area offices would improve the efficiency and effectiveness of the MediPass
program's administration.









Program Cost Analysis


In order to provide an evaluation of program costs, Medicaid claims were
obtained from the three most recently completed fiscal years. Complete claims data for
Fiscal Years 1997-98 through 1999-00 was analyzed using CompareCareTM, data
processing software provided by ACS, Inc. The CompareCareTM software is designed to
organize, classify, and adjust health care claims data based on age, gender, morbidity,
eligibility category and program participation. Adjustments are made based on the
Adjusted Clinical Groups (ACG) methodology which assigns a single value describing an
individual's health status to each individual in the population. The ACG considers all
diagnoses from all settings and provider types to assign individual values. The values
obtained from all individuals in the population are then used to predict the expected
resource use for the specified group over one year.
Using this software, MediPass program costs in the inpatient hospital, physician
and professional (includes physician fees, durable medical equipment and
transportation), outpatient facility, and pharmacy service categories were analyzed in
comparison to a standard group. In these comparisons, the statewide Medicaid
population (excluding HMO enrollees and enrollees over age 65) was used as the
standard group. While controlling for age, gender and morbidity levels of the recipients,
the software produces an expected dollar value for the costs that the MediPass program
would have used if the program recipients used resources at the same rates as the
standard population. Table 2 provides the expected and actual costs and per member
per month costs for all service categories for the entire MediPass program which
includes all recipients enrolled in the MediPass program.
According to Table 2, the MediPass program achieves total cost savings per
member per month of $32.59 for FY 97-98, $40.66 for FY 98-99, and $38.54 for FY
99-00. The greatest savings are realized in the Inpatient Hospitalization and
Physician/Professional service categories with very modest savings being realized in the
Outpatient Facility and Pharmacy service categories.














MediPass Expected vs. Actual Costs All Eligibility Categories
FY Service Category Expected $ Expected PMIPM Actual $ Actual PMIPM Savings PMIPM
1997-98 Inpatient 464,345,503.84 79.01 346,292,994.08 58.92 20.09
Physician/Prof 582,690,762.71 99.15 513,920,927.70 87.45 11.70
Outpatient Facility 77,235,264.06 13.14 73,013,867.10 12.42 0.72
Pharmacy 306,958,501.90 52.23 306,493,192.43 52.15 0.08
All Services 1,431,230,032.52 243.53 1,239,720,981.31 210.94 32.59
Total Member Months FY 97-98 5,877,065


1998-99 Inpatient 417,117,327.83 79.88 299,421,500.39 57.34 22.54
Physician/Prof 546,306,747.18 104.62 455,698,696.43 87.27 17.35
Outpatient Facility 70,377,491.58 13.48 66,670,417.58 12.77 0.71
Pharmacy 350,153,538.04 67.05 349,842,337.48 67.00 0.06
All Services 1,383,955,104.63 265.03 1,171,632,951.88 224.37 40.66
Total Member Months FY 98-99 5,221,890

1999-00 Inpatient 437,265,300.18 72.17 316,653,901.26 52.27 19.91
Physician/Prof 588,188,005.49 97.08 487,163,497.78 80.41 16.67
Outpatient Facility 79,292,961.90 13.09 76,703,087.99 12.66 0.43
Pharmacy 437,671,710.94 72.24 428,411,611.55 70.71 1.53
All Services 1,542,417,978.51 254.59 1,308,932,098.58 216.05 38.54
Total Member Months FY 99-00 6,058,523


Analysis of the Temporary Assistance for Needy Families (TANF) eligibility
category illustrates that total per member per month savings are greater for this specific
eligibility category than for the program in general. Table 3 provides the expected and
actual total and per member per month costs for all service categories for MediPass
enrollees in the TANF eligibility category.














MediPass Expected vs. Actual Costs TANF Eligibility Category
FY Service Category Expected $ Expected PMIPM Actual $ Actual PMIPM Savings PMIPM
1997-98 Inpatient 143,006,548.78 46.19 83,185,402.01 26.87 19.32
Physician/Prof 245,897,057.88 79.43 188,872,730.46 61.01 18.42
Outpatient Facility 37,127,799.00 11.99 36,331,906.99 11.74 0.26
Pharmacy 88,248,079.22 28.51 62,054,829.54 20.04 8.46
All Services 514,279,484.89 166.12 370,444,869.00 119.66 46.46
Total Member Months FY 97-98 3,095,844

1998-99 Inpatient 109,716,868.54 43.66 61,499,672.22 24.47 19.19
Physician/Prof 213,194,624.41 84.84 161,020,923.14 64.08 20.76
Outpatient Facility 30,321,880.09 12.07 29,768,497.37 11.85 0.22
Pharmacy 88,890,687.46 35.37 65,371,978.19 26.01 9.36
All Services 442,124,060.50 175.94 317,661,070.92 126.41 49.53
Total Member Months FY 98-99 2,512,871

1999-00 Inpatient 118,677,233.58 43.11 65,555,390.87 23.81 19.29
Physician/Prof 226,728,302.70 82.35 174,111,178.42 63.24 19.11
Outpatient Facility 32,806,318.67 11.92 33,056,255.00 12.01 (0.09)
Pharmacy 111,358,076.00 40.45 73,831,962.57 26.82 13.63
All Services 489,569,930.94 177.82 346,554,786.86 125.87 51.94
Total Member Months FY 99-00 2,753,204




According to Table 3, the MediPass program achieves cost savings for the TANF
population in all years and service categories except the Outpatient Facility category in
FY 99-00. In FY 97-98 and 98-99 the savings in this category are very small. In
contrast, the savings in all other service categories: Inpatient Hospitalization, Physician
and Professional Services and Pharmacy are significant for the TANF population.

Analysis of the Supplemental Security Income (SSI) eligibility category illustrates
that total per member per month savings are minute compared to the savings achieved
with the TANF population. Table 4 provides the expected and actual total and per
member per month costs for all service categories for MediPass enrollees in the SSI
eligibility category.














MediPass Expected vs. Actual Costs SSI Eligibility Category
FY Service Category Expected $ Expected PMIPM Actual $ Actual PMIPM Savings PM IPM
1997-98 Inpatient 294,133,142.97 184.02 246,512,682.25 154.22 29.79
Physician/Prof 258,630,085.49 161.81 270,842,037.48 169.45 (7.64)
Outpatient Facility 27,317,660.31 17.09 24,718,096.54 15.46 1.63
Pharmacy 202,168,171.77 126.48 230,074,388.70 143.94 (17.46)
All Services 782,249,060.54 489.39 772,147,204.97 483.07 6.32
Total Member Months FY 97-98 1,598,406

1998-99 Inpatient 279,523,530.98 184.22 224,583,166.40 148.01 36.21
Physician/Prof 244,827,145.18 161.36 239,606,943.02 157.92 3.44
Outpatient Facility 26,787,986.33 17.65 24,753,377.24 16.31 1.34
Pharmacy 240,772,228.55 158.68 268,225,049.21 176.78 (18.09)
All Services 791,910,891.04 521.92 757,168,535.87 499.02 22.90
Total Member Months FY 98-99 1,517,306

1999-00 Inpatient 280,780,832.82 185.69 231,383,340.28 153.02 32.67
Physician/Prof 238,467,283.69 157.70 233,302,237.32 154.29 3.42
Outpatient Facility 27,224,297.74 18.00 25,624,624.09 16.95 1.06
Pharmacy 293,800,964.01 194.30 329,885,857.41 218.16 (23.86)
All Services 840,273,378.25 555.70 820,196,059.10 542.42 13.28
Total Member Months FY 99-00 1,512,110



The greatest savings for the SSI population are achieved in the Inpatient
Hospitalization service category. The total savings per member per month are mitigated
by the lack of savings in the Pharmacy service category. However, the claims data
being analyzed is prior to the implementation of Medicaid's Pharmacy Cost Control
Program which did not begin until August 2000. Analysis of FY 00-01 when it becomes
available may provide evidence that the cost control procedures put in place have a
positive effect on the per member per month pharmacy costs for MediPass enrollees in
the SSI eligibility category.
It should be noted that the CompareCareTM software was customized to account
for the specific program characteristics of the Florida Medicaid program. In using the
software and creating the comparisons provided, some limitations in the data and
analysis have been observed. For example, claims data for the "Medication's Only"
eligibility category are currently included in the statewide data which may account for
some anomalies in the data since Medicaid pays for these recipients' pharmaceuticals,
but not for their medical care. This group is small in size and thus, should not create
large problems in the data. However, creating a comparison group that does not include
the "Medication's Only" population would allow for more accurate comparisons to be
made. Another example is the exclusion of enrollees over age 65. This exclusion was
made to remove claims for individuals who are dually enrolled in Medicare and Medicaid
since the payments made by Medicaid do not reflect the accurate costs and morbidity
levels for individuals in this group. However, by just excluding enrollees over ago 65,









some dually enrolled individuals are still included since they are under age 65 and
eligible for Medicare because of a disability status. Again, this does not amount to a
large number of cases, but does result in limiting the ability to make valuable
comparisons. In addition, because of limitations in the groups available for comparison,
the observed differences illustrated above may be understated since the MediPass
population is included in the standard population and thus expected values are based on
the combined resource usage experience of the MediPass and non-MediPass
populations of the Florida Medicaid program. It is obvious that further customization of
the program could reduce some of the limitations to the program and provide Medicaid
with a powerful tool for assessing resource usage and enhancing data-driven decision-
making abilities.




Summary of Recipient Survey Data


A sample of enrollees (n=3469) in Florida's HMO, PSN and MediPass programs
were surveyed to assess their satisfaction with their health care provider and service
delivery. Data were collected by telephone using a standardized patient satisfaction
questionnaire, the Consumer Assessment of Health Plans Survey (CAHPS). The
CAHPS survey is a standardized instrument developed to help consumers identify the
best health care plans. Because of time constraints for the evaluation, existing survey
data from the Provider Service Network (PSN) Demonstration Project Evaluation was
obtained and analyzed to provide a proxy measure of MediPass recipient satisfaction.
Since the data for the PSN project was collected only for Dade and Broward counties, it
may not be representative of the state as a whole. However, the data provided here is
representative of previous results of MediPass recipient satisfaction. A statewide survey
of MediPass recipients will be conducted and reported as an addendum to this report
later in the year.
In general, participants in HMO, PSN and MediPass programs reported a high
level of satisfaction with the medical care they receive as well as the administrative
process and procedures associated with their medical care. Respondents indicated that
they experienced few or no problems in finding a personal doctor, obtaining referrals, or
having to delay care while waiting for program approvals, and very few respondents
have called or written to express complaints about either HMO, PSN and MediPass
programs. Greater than 75% of respondents reported satisfaction in their relationship
with primary care physicians or other health care providers, rating positively such items
as listening carefully, explaining things clearly, and spending sufficient time with patients.
Similarly, most respondents reported staff at their physician's office staff to be respectful,
helpful and courteous.
Differences between HMO, PSN and MediPass programs were modest, with
observed differences tending to indicate a higher level of satisfaction among MediPass
participants. Appendix E contains tables of all actual data collected including specific
questions asked, response frequencies and percentages, and standard errors.









Methodology

Analysis of Operations and Program Administration
Analysis of the operations and program administration is based on extensive
reviews of all available policies, procedures and documents obtained from the MediPass
program, as well as reviews of all relevant Medicaid, Primary Care Case Management
(PCCM), and managed care literature. In addition, in-depth interviews of Agency
personnel from the headquarters and a sampling of the Area Offices were conducted.
FCMI also held a workshop to discuss PCCM best practices with national and state
experts.


Program Costs Analysis
The program cost analysis was conducted using the CompareCareTM software
developed by AdvanceMed, Inc. and installed as part of the Florida Rapid Entry to
Enhanced Data Online for Medicaid (FREEDOM) information system provided by ACS,
Inc. (formerly Consultec, Inc.), Florida Medicaid's fiscal agent. CompareCareTM uses the
Adjusted Clinical Group (ACG) classification method. This methodology enables
comparison of different patient groups by controlling for important factors, such as age,
gender, and morbidity, which influence utilization and medical costs. Using this system,
expected values are calculated using the standard population of all Florida Medicaid
recipients. Expected costs are produced based on the MediPass population and the
statewide Medicaid population adjusted to have equal distributions of age, gender, and
morbidity levels and the resource usage experienced by the statewide Medicaid
population. This allows for comparisons between actual costs and expected costs to
calculate cost savings. This methodology may result in some understatement of
observed differences since the MediPass population is included in the standard
population and thus expected values are based on the combined resource usage
experience of the MediPass and non-MediPass populations of the Florida Medicaid
program.


Recipient Survey
For analysis of recipient satisfaction, a random sample of adult Medicaid
enrollees (n=3469) in HMO, PSN and MediPass programs in Dade and Broward
counties were surveyed by telephone regarding their satisfaction, using a standardized
patient satisfaction questionnaire, the Consumer Assessment of Health Plans Survey
(CAHPS).
The sample was constructed through a series of steps. First, participating HMOs
provided the survey lab with lists of enrollees that were "randomly selected" and included
current address and telephone information. Each HMO was asked to provide a list of
2000 enrollees. Information on precisely how the HMOs extracted the lists is sparse and
the lists received were highly variable. Some contained more than 2000 cases, some
less, while some HMOs provided lists in waves, some in a single transmittal. Many
entries had no telephone numbers; many others had non-functional numbers (out-of-
date, incorrect, disconnected, etc.). Despite these and other issues, 3469 interviews
were completed to form the statewide sample.









Since the final distribution of Medicaid plans differed from the known HMO
market share, post-stratification was performed using a procedure outlined by Aday6.
Post-stratification weights were calculated by dividing known market share proportion for
each Medicaid plan by its corresponding proportion observed in the sample. The final
weight was then obtained by scaling the post-stratification weights so that the number of
cases was down weighted to equal the actual sample size. The scaling step consisted of
dividing each post-stratification weight by the mean of all the computed post-stratification
weights.











































6 Designing and conducting health surveys: a comprehensive guide by Lu Ann Aday; foreword by Ronald
M. Andersen, Jossey-Bass Publishers, 1996, San Francisco, CA.









References


1. Medicaid Managed Care: A Guide for States, Fifth Edition, by Neva Kaye, May
2001, National Academy for State Health Policy, Funded by the Henry J. Kaiser
Family Foundation, The Health Resources and Services Administration, The
David and Lucile Packard Foundation, and the Congressional Research Service.

2. Surveyor Guidelines for the Accreditation of MCOs, National Committee for
Quality Assurance, effective July 1, 2001.

3. Medicaid Managed Care Review-Final Version, Texas Health and Human
Services Commission, November 1, 2000.

4. Access to Medicaid Physician Specialists, Agency for Health Care
Administration, November 2000.

5. Introduction to Health Services, 4th Edition, Edited by Stephen J. Williams, Sc.D.,
and Paul R. Torrens, M.D., M.P.H., Delmar Publishers lnc.1993, Albany, New
York.

6. Designing and conducting health surveys: a comprehensive guide by Lu Ann
Aday; foreword by Ronald M. Andersen, Jossey-Bass Publishers, 1996, San
Francisco, CA.









APPENDIX A: MEDIPASS NETWORK CAPACITY





MediPass Network Capacity by County



#ofPCPslGroups #ofPCPslGroups
Total Total PCP Available Average# of Total# of with < 50 with < 100
MediPass Requested Excess Slots Patients per Contracted Requested Requested
County Enrollees Capacity Capacity per Enrollee PCPIGroup PCPslGroups* Capacity Capacity

Escambla 18,473 61,735 43,262 3 169 109 22 52

Okaloosa 8,493 22,093 13,600 3 243 35 8 13

Santa Rosa 5,120 28,676 23,556 6 125 41 8 21

Walton 3,260 15,097 11,837 5 204 16 3 4

Area 1 Totals 35,346 127,601 92,255 4 176 201 41 90


Bay 13,593 78,184 64,591 6 216 63 4 8

Calhoun 1,471 11,220 9,749 8 147 10 0 1

Franklin 922 17,899 16,977 19 61 15 0 0

Gadsden 4,001 18,150 14,149 5 364 11 0 0

Gulf 1,219 15,825 14,606 13 102 12 0 1

Holmes 2,383 13,875 11,492 6 238 10 0 0

Jackson 4,359 43,899 39,540 10 168 26 0 0

Jefferson 916 8,450 7,534 9 153 6 0 0

Leon 9,375 71,006 61,631 8 195 48 8 14

Liberty 556 5,350 4,794 10 185 3 0 0

Madison 1,602 17,602 16,000 11 134 12 1 1

Taylor 2,380 16,495 14,115 7 198 12 0 0

Wakulla 1,072 11,200 10,128 10 179 6 0 0

Washington 2,259 22,440 20,181 10 141 16 0 0

Area 2 Totals 46,108 351,595 305,487 8 184 250 13 25


Alachua 13,192 66,066 52,874 5 269 49 13 14

Bradford 2,057 18,350 16,293 9 206 10 0 0

Citrus 5,712 44,157 38,445 8 133 43 11 12

Columbia 6,043 27,578 21,535 5 288 21 1 3

Dixie 1,593 12,060 10,467 8 319 5 0 0

Gilchrist 1,093 7,137 6,044 7 219 5 0 0

Hamilton 1,647 4,449 2,802 3 275 6 0 0

Hernando 2,666 30,220 27,534 11 90 30 3 7

Lafayette 603 4,150 3,547 7 151 4 0 0

Lake 7,748 71,185 63,437 9 129 60 9 11

Levy 2,646 15,480 12,834 6 139 19 3 4

Marion 18,967 72,591 53,624 4 316 60 12 16

Putnam 6,955 34,010 27,055 5 316 22 1 3

Sumter 5,405 18,350 12,945 3 676 8 0 0

Suwannee 3,272 14,999 11,727 5 234 14 1 1

Union 825 7,975 7,150 10 138 6 0 0

Area 3 Totals 80,444 448,757 368,313 6 222 362 54 71


Baker 1,190 14,825 13,635 12 99 12 0 1

Clay 3,312 46,951 43,639 14 79 42 4 6

Duval 30,710 279,836 249,126 9 171 180 20 25

Flagler 1,780 0 -1,780 0 N/A 0 0 0

Nassau 1,530 7,930 6,400 5 170 9 3 3

St Johns 4,497 19,338 14,841 4 196 23 8 9

Volusia 19,478 88,845 69,367 5 235 83 6 12

Area 4 Totals 62,497 457,725 395,228 7 179 349 41 56









APPENDIX A: MEDIPASS NETWORK CAPACITY





MediPass Network Capacity by County



#ofPCPslGroups #of PCPslGroups
Total Total PCP Available Average # of Total # of with < 50 with < 100
MediPass Requested Excess Slots Patients per Contracted Requested Requested
County Enrollees Capacity Capacity per Enrollee PCPIGroup PCPs/Groups* Capacity Capacity

Pasco 11,412 94,674 83,262 8 116 98 17 24

Pinellas 23,973 318,607 294,634 13 88 271 53 69

Area 5 Totals 35,385 413,281 377,896 12 96 369 70 93


Hardee 3,552 19,050 15,498 5 296 12 0 0

Highlands 5,036 41,575 36,539 8 157 32 0 3

Hillsborough 33,557 348,235 314,678 10 123 273 28 42

Manatee 5,677 52,252 46,575 9 135 42 8 12

Polk 14,056 120,875 106,819 9 153 92 7 9

Area 6 Totals 61,878 581,987 520,109 9 137 451 43 66


Brevard 13,220 98,372 85,152 7 119 111 21 32

Orange 35,495 243,493 207,998 7 151 235 41 60

Osceola 5,249 48,358 43,109 9 94 56 6 7

Seminole 4,276 63,791 59,515 15 66 65 14 22

Area 7 Totals 58,240 454,014 395,774 8 125 467 82 121


Charlotte 4,487 17,952 13,465 4 214 21 3 4

Collier 10,550 71,257 60,707 7 229 46 9 12

DeSoto 2,863 30,031 27,168 10 179 16 0 1

Glades 47 1,545 1,498 33 24 2 0 0

Hendry 3,359 37,368 34,009 11 177 19 0 1

Lee 12,478 120,758 108,280 10 117 107 25 30

Sarasota 4,788 47,101 42,313 10 78 61 14 17

Area 8 Totals 38,572 326,012 287,440 8 142 272 51 65


Indian River 5,036 22,148 17,112 4 296 17 2 2

Martin 3,848 33,900 30,052 9 124 31 0 4

Okeechobee 3,316 17,125 13,809 5 276 12 0 0

Palm Beach 28,808 278,540 249,732 10 153 188 9 11

StLucle 13,204 57,952 44,748 4 307 43 1 1

Area 9 Totals 54,212 409,665 355,453 8 186 291 12 18


Broward 33,756 623,139 589,383 18 80 424 30 52

Area 10 Totals 33,756 623,139 589,383 18 80 424 30 52


Dade 125,129 1,815,435 1,690,306 15 103 1,218 17 47

Monroe 3,398 23,848 20,450 7 110 31 5 8

Area 11 Totals 128,527 1,839,283 1,710,756 14 103 1,249 22 55


Statewide Totals 634,965 6,033,059 5,398,094 10 136 4,685 459 712


*MediPass allows providers to enroll as individuals or as groups so the number of actual providers is understated






APPENDIX B: MEDIPASS CREDENTIALING POLICIES


I. CRITERIA FOR ENROLLMENT:

1. Providers enrolling in the MediPass program agree to adhere to the terms specified
in the
Medicaid Provider Agreement and the Agreement for Participation in MediPass.

2. The Agreement for Participation in MediPass includes credentialing standards that
follow the policies and procedures of the MediPass Credentialing initiative and the
provider must:

a. Have sent a completed Medicaid agreement with a copy of each provider's
current medical, nursing, or physician's assistant license to Medicaid's
fiscal agent and be an approved Medicaid provider. The practitioner's
active licensure shall suffice in lieu of professional liability coverage
requirements.

b. Have no current license revocation or suspension of the provider's state
license by the state licensing board.

c. Have no sanctions in effect on the primary care provider by Medicaid or
Medicare.

d. Have no ongoing investigations) by Medicaid Program Integrity,
Medicare, Medical Quality Assurance or other governmental entities, with
the exception of routine utilization reviews, including SURS reviews.
This requirement applies to new applicants only.

e. Have privileges in good standing at the hospital designated as the primary
admitting facility by the primary care provider, or, if the provider does not
have admitting privileges, privileges in good standing at the hospital by
another provider with whom the primary care provider has entered into an
arrangement for hospital coverage.

f Have submitted copies of valid Drug Enforcement Administration (DEA)
certificates, if prescribing controlled substances.

g. Have attested that the total active patient load (all populations with
Medicaid Fee-For-Service, Medicaid Prepaid Health Plan, Health
Maintenance Organization [HMO], Provider Service Network [PSN],
Medicare or commercial coverage) is no more than 3,000 patients per
primary care provider. An active patient is one that is seen by the
professional a minimum of three times per year.

h. Have received a satisfactory MediPass credentialing site visit survey.

i. Have attested to the correctness/completeness of the MediPass provider's
application.






APPENDIX B: MEDIPASS CREDENTIALING POLICIES
j. Have made a statement regarding any history of loss or limitation of
privileges or licensure activity.

k. Have submitted a current curriculum vitae which includes educational
history and at least five years of work history with an explanation of any
gaps of more than 30 days that appear within the five-year work history.

1. Have submitted detailed information regarding cases resulting in
judgments within the past five years.

3. Only providers serving as primary care providers will undergo the credentialing
process. This will apply to MDs, DOs, ARNPs, and PAs who serve as primary
care providers. Credentialing of ARNPs and PAs when used as extenders is not
required because they are working under the direct supervision of a credentialed
MediPass provider. The monitoring and enforcement of this collaborative
agreement is a responsibility of Medicaid.

II. AREA OFFICE CREDENTIALING PROCESS:

1. Upon receipt of a complete application package, a MediPass staff member
will review the package for accurate completion of the following:

a. Agreement for Participation in MediPass and MediPass Provider
Enrollment Form containing original signatures. Faxed or
photocopied forms are not acceptable.

b. Copy of a current curriculum vitae which includes educational
history and work history for the past five years with an explanation
of any gaps of more than 30 days in work experience.

c. Completion of the "Verification of Hospital Privileges" form
indicating the facility where admissions occur and the signature of
the provider who admits the patients.

d. Copy of current DEA certificate, if applicable.

2. Following the receipt of a correctly completed credentialing package, area office
staff will perform a credentialing site visit. Then the completed application and
site survey will be forwarded to the Credentialing Liaison at headquarters for
further processing of the application.

3. After three attempts are made by area office staff to obtain information, one of
which must be via certified mail, the area office may close the file of the new
applicant.

In order to terminate the participation of a currently enrolled MediPass provider,
three attempts to request recredentialing information necessary for completion of
the recredentialing process must be made. The first request for recredentialing
information takes place when the provider is sent the recredentialing letter
(generated by FRAES) 120 days prior to the physician's recredentialing date. The






APPENDIX B: MEDIPASS CREDENTIALING POLICIES
provider has 60 days to respond. If a completed credentialing package is not
received within 60 days, area office staff will need to make two additional
attempts to gather the necessary documentation. One of these attempts must be
made via certified letter. If a completed credentialing package is not received
following the three attempts, then a termination letter and documentation to
support the closure must be sent to headquarters for processing and final approval.

III. Headquarter's Credentialing Process:

1. Upon receipt of a completed credentialing package and site survey, the
headquarters network management team (within the Bureau of Medicaid
Program Development) will process the application by doing the following:

a. Reviewing the application to ensure receipt of the curriculum vitae,
five-year work history, DEA certificate, hospital verification form,
application, enrollment form, educational history, site survey
containing area staff's comments and recommendations and
verification of the provider's cap.

b. Printing of FMMIS screens to verify the DEA number, medical
license number, address, phone number, Social Security number,
and cap of the provider.

c. Opening an application in FRAES for the purpose of updating and
tracking provider credentialing/recredentialing information and
activities.

d. Producing and mailing letters to the Agency's Program Integrity Unit
to determine if there are any open investigations on new provider
applicants and a hospital privilege letter to the hospital designated
on the "Verification of Hospital Privilege" form to verify the status of
the provider's privileges at the hospital.

e. Searching the Department of Health Web site to verify the status of
theprovider's medical license.

f. Querying the National Practitioner Data Bank to determine if there
have been any malpractice settlements on behalf of the physician or
any adverse actions (loss of clinical/licensure privileges) taken
against the provider.

g. Searching the Heath and Human Service Office of the Inspector
General Website to review the Reinstatement/Exclusion Report to
determine if any Medicare or Medicaid sanctions have been taken
against the provider by the Office of the Inspector General.

IV. ASSIGNMENT OF PROVIDERS TO CATEGORIES:


Upon completion of the verification process, provider applications will be
assigned to one of the following categories and presented to the Credentialing
Committee:






APPENDIX B: MEDIPASS CREDENTIALING POLICIES


Category 1: Providers who have been credentialed within the past 18
months by another group whose credentialing or accreditation process
includes standards at least comparable to MediPass. These groups include
Medicaid HMOs, HMOs with full NCQA accreditation and JCAHO-
accredited networks. Providers in one of these networks will be enrolled in
MediPass upon receipt of an approval or reappointment letter and evidence of
a satisfactory report on a credentialing site survey conducted within the past
12 months.

Category 2: Providers who have been credentialed by groups discussed in
Category 1 more than 18 months ago, but within the past 24 months.
These providers will receive provisional approval to participate in MediPass
upon receipt of an approval or reappointment letter and evidence of a
satisfactory report on a credentialing site survey conducted within the past 12
months, but will be re-evaluated by headquarters credentialing liaisons after
receipt of evidence of their re-credentialing by the entities outlined in
Category 1. Documentation indicating the provider has been re-credentialed
by one of the aforementioned groups must be received by the MediPass
program at least 60 days before the scheduled re-credentialing date.

Category 3:Providers who are not eligible or are disqualified from
participation in the MediPass program due to circumstances that are not
in the best interest of the Agency. These circumstances may include, but are
not limited to:

a. Providers who do not possess an active Florida medical, nursing, or
physician assistant license (or, for providers within 50 miles of Florida, an
active license to practice in their home state);

b. Providers currently under Medicaid or Medicare sanction;

c. Providers who prescribe controlled substances and do not possess DEA
certification;

d. Providers who at the time of initial application are under investigation for
fraud or abuse, with the exception of routine utilization reviews including
SURS;

e. Providers who do not have active admitting privileges and who have not
made an arrangement for hospital coverage with an individual who
possesses such privileges;

f Providers who have limitations or conditions on their licensure due to acts
of sexual misconduct;
g. Providers who have paid three or more malpractice claims (judgments)
within the past five years based on the date of act/omission;






APPENDIX B: MEDIPASS CREDENTIALING POLICIES
h. Providers who have materially misrepresented facts on application
materials; and/or

i. Providers who were previously terminated and upon reapplication did not
have the support of the area office. Documentation indicating current
findings that support the area office recommendation must be submitted to
headquarters for consideration during the credentialing process.

Category 4: Providers who have "exceptions" identified during the
verification phase. This would include:

a. Providers receiving an unsatisfactory report on the credentialing site
survey;

b. Providers whose Florida professional licenses have limitations or
restrictions;

c. Providers who have a history of loss or limitation of hospital privileges not
related to administrative functions, i.e. quality of care issues;

d. Providers having paid any malpractice court judgments within the past
three years (based on the National Practitioner Data Bank [NPDB] query
date). If the date the physician supplies supporting information about the
judgment is past the 3-year mark, the provider file will continue to be
handled as a category 4 since the judgment date was within 3 years of the
NPDB query date;

e. Providers who have been previously found to be out of compliance with
the terms and conditions of Medicaid or MediPass agreements;

f Providers who have had their license suspended or revoked by another
state;

g. Providers who have been identified as having patients that are
overutilizers of emergency room services;

h. Providers who have been identified as pharmaceutical outliers by the
prescribed drug utilization review committee;

i. Other discrepancies that cannot be resolved by credentialing staff; and

j. These providers will be considered individually by the Credentialing
Committee as described subsequently under "Credentialing Committee
Actions."

Category 5: Providers who have met the criteria specified in the
MediPass Credentialing Standards (Section I) that do not fall into
categories 1 through 4. The names of these providers will be furnished to
the Credentialing Committee as having met criteria and will be enrolled in






APPENDIX B: MEDIPASS CREDENTIALING POLICIES
MediPass or continue their participation in MediPass upon completion of
verifications.

V. CREDENTIALING COMMITTEE COMPOSITION:

The MediPass Credentialing Committee consists of five members: two
physicians, two nurses, and the MediPass Program Administrator or
designee. A quorum is defined as having at least three members consisting
of one physician, one nurse, and the MediPass Program Administrator or
designee. All committee members are appointed or reappointed every two
years by the Chief of Medicaid Program Development.

VI. CREDENTIALING COMMITTEE ACTIONS:

1. The Credentialing Committee will be provided with a list of providers meeting
the criteria specified in Categories 1, 2, and 5 for its consideration and
approval.

2. The Credentialing Committee will be provided with a list of providers in
Category 3 who are not eligible or are disqualified from participation in the
MediPass program at the current time and the reasons) for non-eligibility. If
appropriate, the committee may recommend further action on the part of the
provider.

3. The Credentialing Committee will consider the complete file of applicants in
Category 4, to include the nature of the exception noted, extenuating
circumstances, and whether the exception is related to the provision of medical
care. Members will then vote for one of the following actions:

a. Approve

b. Deny

c. Obtain further information

d. Require additional action be taken by the provider

e. Conditionally credential

In order to approve a MediPass provider, a simple majority of Credentialing
Committee members must be present and voting.

VII. RE-APPLICATION OF MEDIPASS PROVIDERS:

Providers who are denied participation in MediPass will be informed
of the MediPass Credentialing Committee's decision. A provider may re-
apply at any time.

VIII. RE-CREDENTIALING OF MEDIPASS PROVIDERS:






APPENDIX B: MEDIPASS CREDENTIALING POLICIES


1. All MediPass providers will be re-credentialed every two years. Four months
prior to the expiration of the original credentialing date, a notice will be sent to
the provider, along with a package of re-credentialing materials and
instructions for completion of the forms. If the provider has not responded
within 60 days with the necessary documentation, area office staff will make
two additional attempts to gather the needed information from the provider.
One of these attempts must be via certified mail.

2. All information relevant to the provider, including tracking information such
as complaints, grievances, applicable utilization reports, etc., will be kept in the
provider's file at the area office and forwarded to headquarters for
consideration during the re-credentialing process.

IX. CONFIDENTIALITY and DISCLOSURE OF CREDENTIALING
INFORMATION:


1. Provider files undergoing credentialing will be kept in locked file cabinets.
Access to those files will be restricted to only those staff members who have
signed a confidentiality statement and who must access the files for the sole
purpose of discharging their respective responsibilities. Additionally, all
members of the credentialing committee will sign confidentiality statements.

2. Data (excluding information revealed by the National Practitioner DataBank)
obtained during the credentialing process may be disclosed in the following
circumstances:

a. With the consent of the provider involved;

b. When authorization is received from the Agency for Health Care
Administration General Counsel's office pursuant to a Public Records
Release;

c. If requested in writing by any professional licensing board; or

d. To fulfill reporting requirements by state or federal law.


Effective 4/1/2001





















FLMS3100-R001


FLMS3100-R001 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION
MEDICAID MANAGEMENT INFORMATION SYSTEM
MEDIPASS PROVIDER UTILIZATION SUMMARY
FOR DATES OF SERVICE 06/01/01 THROUGH 06/30/01
DISTRICT: 01
COUNTY: 17 ESCAMBIA
GROUPING: GEN AND FAM PRACTICE
****************** SERVICES AUTHORIZED PER 100 PATIENTS*******************


EM
OFFICE
PROVIDER VISITS V

(0100765-23)
SHMG/CARRIAGE HILLS FCC 3.51
(0100765-25)
SHMG/PERDIDO BAY FCC 9.85
(0100765-26)
SHMG/MILESTONE FCC 6.45
(0100765-28)
SHMG/PACE FCC 35.59
(0404381-00)
ROBINS, ROSS AARON 0.00(U)
(0417041-00)
BELK, WILLIAM W. 0.00(U)
(0445975-00)
DELAROSA, CARMEN R. MD 0.00(U)
(0483184-00)
DU LIENG, KIM T. MD 20.56
(0490792-00)
FRENCH, BARBARA O. MD 75.00(0)
(0492621-00)
MAY, JOHN L. 0.00(U)
(0508730-00)
BROWN, JOHN G., D.O. 50.00(0)
(0515639-00)
BELLARD, RICKY L., M.D. 0.00(U)
(0517291-00)
DINOLOV, VAL J., M.D. 5.26
* EMERGENCY ROOM DATA REFLECTS THE


IERGENCY
ROOM OUTPATIENT PHYSICIAN /HOSPI-fi.r~LAB & XRAY
ISITS* VISITS REFERRALS ADMISSIONS PROCEDURES THERAPIES
---- ----- --------- ---- --- ---


4.39

3.03

3.23

3.39

. 0 (U))

8.33

2.94

0.93

0.00(U)

5.26

0.00(U)

9.62


1.75

3.03

6.45

10.17

0.00(U)

30.56(0)

7.35

0.00(U)

75.00(0)

10.53

0.00(U)

36.54(0)


20.18

15.91

14.52

21.19

16.67

38.89

17.65

2.80

75.00

63.16

0.00(U)

44.23


0.00(U)

0.00(U)

0.00(U)

0.00(U)

0.00(U)

0.00(U)

0.00(U)

0.00(U)

0.00 (U)

0.00(U)

0.00(U)

0.00(U)


51.75

43.94

3.23

37.29

16.67

25.00

2.94

28.04

25.00

57.89

0.00(U)

7.69


PAGE 1
RUN DATE 09/23/01


# OF AVERAGE
MEDIPASS COST PER
DME PATIENTS PATIENT


0.00(U) 1.75

0.00(u) 3.03

0.00(U) 0.00(U)

0.00(U) 0.00(U)

0.00(U) 0.00(U)

0.00(U) 8.33

0.00(U) 2.94

0.00(U) 0.00(U)

0.00(U)1600.00(0)

0.00(U) 36.84

0.00(U) 0.00(U)

0.00(U) 0.00(U)


114 $17.14

132 $25.31

62 $29.97

118 $43.40

6 $11.77

36 $81.70

68 $19.56

107 $13.42

4 $100.73

19 $63.05

2 $13.15

52 $60.02


0.00(U) 10.53 21.05 0.00(U) 31.58 0.00(U) 15.79 19 $23.06
MEDIPASS PROVIDERS AUTHORIZATION OF EMERGENCY ROOM TREATMENT FOR NON-EMERGENCY SITUATIONS.


Page 1 o








APPENDIX D: North Carolina Access Program Physician Profile


P advancemed
B i


PCP Utilization
Age Gender and ACG Adjusted
Dollar Basis: Allowed


1, Identl~ing Information
Narne Reporting Period D14131,1999 o I W,V 999
ConlrisorGrop NETWORK=1
I) PRV19026 Pkailed NWlMMdYdH hwdbx 1.09
Spruamiy Ptmnrv m CaniprisonR MoribitfityInRde 1.00
IIt Patieni Characteristics
Age Group e Ollnssurden by Morbidit Luvci







A _____1___I




0lL Utilization Summary feflC "iM CmaSrto"rsnUifoi
C ( Patient Count (5)PMPM$
PiaresreIoa 52 409 955 22,6M5 177 12,400,8 GAR

Oupfet7 3-17 2,22D Z9 54 Z145,075 G.41
Lob-! h'ax-o.2 1 42.1? 3.irn64 .12. 1,68
10* 3 10.27 7,42D 1.114 1032 .09 121
Ro4rm 14"11h I D,5 e$313 ASS 100,254 21`
ER4 1-19 W ~ 2,121 211 968 3


Paliani Comparison Cornparlisn Comparison, Itilizallon
Caount (11 PMPMA Total (5) Pat~ent Count (&I PMPM ToWal(S) Index (5)
Prof-D*Pgi'o Rad*Wg 2135 07 3.3 48 ISM 772 0.81
Praf-OLDc~ic llnotrurkd 5 0,72 519 1,01 1 1.2 21 2BI27 D.37
PrfEav~ n oqmn 44 1244 84" JOAN2 12,25 IM70 O0*1
PJUV-M~dEE, 29 1 7 4.914 $. 5 1.42
P~ro(Sun aeffeDelioery 2 2.83 2046 272 2.32 390748 0.94
Rxecb~nee~s2 1-14 82 4,5 01 170 4B3 0
Rx-ftheathrmatie 2 04 a740.351983 1.20]
Rhftnntf** 2 0.15I 071 0.02
Rx-Gasrlrftshnal 9 Z 143 1,056 1.4~3 241700O 17A4
RxHypoglcnu 0 0.00 0 241 0,41 6925 000
5 ".4 Z46 1.678 241 476-47 W


PracltiScari


MoM2O1I


VH "17 ;:AM







APPENDIX E: Recipient Survey Satisfaction Data Tables


PSN MediPass HMO
Age n=510 n=499 n=1168
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
18-24 73 14.3 1.55 150 30.1 2.05 239.0 16.3 0.46
25-34 66 12.9 1.49 59 11.8 1.45 262.0 17.9 0.19
35-44 107 21 1.8 129 25.9 1.96 257.0 17.5 0.21
45-54 97 19 1.74 88 17.6 1.71 192.0 13.1 0.21
55-64 117 22.9 1.86 66 13.2 1.52 218.0 14.9 0.20
65 or older 50 9.8 1.32 7 1.4 0.53 297.0 20.3 0.35
PSN MediPass HMO
Sex n=517 n=506 n=1555
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Male 159 30.8 2.03 84 16.6 1.66 420.0 27.0 0.14
Female 358 69.2 2.03 422 83.4 1.66 1135.0 73.0 0.08
PSN MediPass HMO
Q3. Received New Doctor or n=501 n=482 n= 1525
Nurse When Enrolled
Nurse When Enrolled Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Yes 138 27.5 2 136 28.2 2.05 697.8 45.8 0.107
No 363 72.5 2 346 71.8 2.05 827.0 54.2 0.096
PSN MediPass HMO
Q4. How Much of a Problem to
Get Satisfactory Doctor or Nurse n=136 n=135 n=671
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Big Problem 16 11.8 2.77 14 10.4 2.63 72.3 10.8 0.31
Small Problem 15 11 2.7 11 8.1 2.36 45.9 6.8 0.41
No Problem 105 77.2 3.61 110 81.5 3.36 552.7 82.4 0.12







APPENDIX E: Recipient Survey Satisfaction Data Tables


PSN MediPass HMO

Q5. Has a Personal Doctor or Nurse n=513 n=504 n=1549
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Yes 317 61.8 2.15 358 71 2.02 1147.0 73..7 0.84
No 196 38.2 2.15 146 29 2.02 408.0 26.3 0.13
PSN MediPass HMO
Q6. Rating of Personal Doctor or Nurse n=310 n=356 n=1083
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
0 through 6 26 8.4 1.58 21 5.9 1.25 99.0 9.1 0.94
7 or 8 48 15.5 2.06 45 12.6 1.76 192.0 17.7 0.29
9 or 10 236 76.1 2.43 290 81.5 2.06 792.0 73.1 0.19
PSN MediPass HMO

Q7. Needed a Specialist n=515 n=503 n=1540
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Yes 215 41.7 2.18 205 40.8 2.19 721.0 46.8 0.11
No 300 58.3 2.18 298 59.2 2.19 819.0 53.2 0.10

Q8. How Much of a Problem to Get PSN MediPass HMO
Referral for Specialist n=212 n=205 n=712
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Big Problem 43 20.3 2.77 27 13.2 2.37 116.0 16.2 0.25
Small Problem 23 10.8 2.14 16 7.8 1.88 87.0 12.2 0.30
Not a Problem 146 68.9 3.19 162 79 2.85 510.0 71.6 0.13
PSN MediPass HMO

Q9. Saw a Specialist n=511 n=501 n=1539
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Yes 177 34.6 2.11 189 37.7 2.17 653.0 42.4 0.11
No 334 65.4 2.11 312 62.3 2.17 886.0 57.6 0.09







APPENDIX E: Recipient Survey Satisfaction Data Tables


PSN MediPass HMO
Q10. Rating of Specialist n=168 n=187 n=633
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
0 through 6 21 12.5 2.56 15 8 1.99 70.0 10.9 1.87
7 or 8 24 14.3 2.71 22 11.8 2.36 110.0 17.3 0.38
9 or 10 123 73.2 3.43 150 80.2 2.92 454.0 71.7 0.24
PSN MediPass HMO
Q11. Specialist Same as Personal Doctor n=175 n=188 n=645
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Yes 65 37.1 3.66 50 26.6 3.23 209.0 32.4 0.20
No 110 62.9 3.66 138 73.4 3.23 436.0 67.6 0.13
PSN MediPass
Q12. Called Doctor's Office for Self During n=515 n=501 n=1546
Regular Hours
Regular Hours Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Yes 170 33 2.07 189 37.7 2.17 577.0 37.3 0.11
No 345 67 2.07 312 62.3 2.17 969.0 62.7 0.09
PSN MediPass HMO
Q13. Received Needed Help or Advice n=166 n=189 n=568
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Never or Sometimes 65 39.2 3.8 40 21.2 2.98 175.0 8.1 0.31
Usually 20 12 2.53 14 7.4 1.91 86.0 22.7 0.30
Always 81 48.8 3.89 135 71.4 3.29 307.0 15.1 0.16
PSN MediPass HMO
Q14. Made Appointment for Regular n=513 n=502 n=1543
Health Care
Health Care Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Yes 273 53.2 2.21 298 59.4 2.19 911.0 59.0 0.09
No 240 46.8 2.21 204 40.6 2.19 633.0 41.0 0.11







APPENDIX E: Recipient Survey Satisfaction Data Tables


PSN MediPass HMO
Q15. Got Appointment for Regular Health n=265 n=295 n=899
Care as Soon as Wanted Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Never or Sometimes 78 29.4 2.8 43 14.6 2.06 213.0 23.8 0.29
Usually 28 10.6 1.89 43 14.6 2.06 154.0 17.1 0.22
Always 159 60 3.02 209 70.8 2.65 532.0 59.1 0.12
Q16. Days Waited Between Making PSN MediPass HMO
Appointment and Seeing Provider n=257 n=282
for Routine Care
for Routine Care Standard Standard
Frequency Percent Error Frequency Percent Error
Same Day to 3 Days 93 36.2 3 185 65.6 2.83
4-14 Days 73 28.4 2.82 74 26.2 2.62
15-29 Days 27 10.5 1.92 7 2.5 0.93
30 Days or More 64 24.9 2.7 16 5.7 1.38
PSN MediPass HMO
Q17. Had Illness or Injury Needing n=515 n=506 n=1548
Immediate Care
Immediate Care Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Yes 169 32.8 2.07 170 33.6 2.1 542.0 35.0 0.12
No 346 67.2 2.07 336 66.4 2.1 1006.0 65.0 0.09
Q18. Got Immediate Care for Illness or PSN MediPass HMO
Injury as Soon as Wanted n=167 n=166 n=536
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Never or Sometimes 56 33.5 3.66 29 17.5 2.96 117.0 21.8 0.37
Usually 14 8.4 2.15 14 8.4 2.16 82.0 15.2 0.29
Always 97 58.1 3.83 123 74.1 3.41 337.0 63.0 0.15







APPENDIX E: Recipient Survey Satisfaction Data Tables


Q19. Days Waited Between Trying to Get PSN MediPass HMO
Care and Seeing Provider for Illness or n=161 n=167
Injury
Standard Standard
Frequency Percent Error Frequency Percent Error
Same Day 99 61.5 3.85 110 65.9 3.68
1-3 Days 24 14.9 2.82 29 17.4 2.94
4-14 Days 14 8.7 2.23 23 13.8 2.67
15 or More Days 24 14.9 2.82 5 3 1.32
Q20. Number of Times Went to PSN MediPass HMO
Emergency Room for Care for Self n=512 n=499 n=1546
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
None 312 60.9 2.16 348 69.7 2.06 1057.0 67.9 0.09
1-2 Times 171 33.4 2.09 116 23.2 1.89 401.0 25.9 0.98
3-5 Times 18 3.5 0.81 27 5.4 1.01 70.0 4.5 0.69
6 or More Times 11 2.1 0.64 8 1.6 0.56 19.0 1.0 0.70
PSN MediPass HMO
Q21. Number of Times Went to Doctor's PSN MediPass HMO
Office or Clinic for Care for Self n=503 n=488 n=1501
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
None 143 28.4 2.01 107 21.9 1.87 384.0 25.6 0.15
1-4 Times 220 43.7 2.21 207 42.4 2.24 800.0 53.2 0.20
5-9 Times 87 17.3 1.69 127 26 1.99 208.0 13.9 0.19
10 or More Times 53 10.5 1.37 47 9.6 1.34 109.0 7.3 0.26
PSN MediPass HMO
Q22. How Much of a Problem to Get N __ n
Necessary Care n=354 n=378 n=1105
Necessary Care
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Big Problem 45 12.7 1.78 28 7.4 1.35 92.0 8.3 0.29
Small Problem 56 15.8 1.94 55 14.6 1.82 137.0 12.4 0.24
Not a Problem 253 71.5 2.4 295 78 2.13 876.0 79.2 0.09







APPENDIX E: Recipient Survey Satisfaction Data Tables


PSN MediPass HMO
Q23. Delays While Waiting for Approval n=350 n
from Program n=350 n=377 n=1105
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Big Problem 45 12.9 1.79 28 7.4 1.35 91.0 8.2 0.28
Small Problem 42 12 1.74 38 10.1 1.55 145.0 13.1 0.22
Not a Problem 263 75.1 2.31 311 82.5 1.96 869.0 78.7 0.09
PSN MediPass HMO
Q24. Waited More Than 15 Minutes Past PSN MediPass HMO
Appointment Time to See Provider n=357 n=376 n=1088
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Never or Sometimes 168 47.1 2.65 248 66 2.45 670.0 61.6 0.15
Usually 48 13.4 1.81 25 6.6 1.29 136.0 12.5 0.23
Always 141 39.5 2.59 103 27.4 2.3 281.0 25.8 0.16

Q25. Office Staff at Doctor's Office PSN MediPass HMO
Were Courteous and Respectful n=359 n=378 n=1107
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Never or Sometimes 45 12.5 1.75 35 9.3 1.49 131.0 11.8 0.39
Usually 21 5.8 1.24 18 4.8 1.1 92.0 8.3 0.28
Always 293 81.6 2.05 325 86 1.79 884.0 79.8 0.09
__-_____-PSN MediPass HMO
Q26. Office Staff at Doctor's Office PSN Med s
Were Helpful n=356 n=375 n=1098
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Never or Sometimes 67 18.8 2.07 50 13.3 1.76 188.0 14.1 0.34
Usually 38 10.7 1.64 45 12 1.68 141.0 12.8 0.23
Always 251 70.5 2.42 280 74.7 2.25 768.0 70.0 0.10







APPENDIX E: Recipient Survey Satisfaction Data Tables


Q27. Doctor or Other Provider PSN MediPass HMO
Listened Carefully n=358 n=378 n=1106
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Never or Sometimes 48 13.4 1.8 36 9.5 1.51 137.0 12.4 0.42
Usually 30 8.4 1.47 19 5 1.13 120.0 10.8 0.25
Always 280 78.2 2.18 323 85.4 1.82 849.0 76.8 0.10
Q28. Had Hard Time Speaking With or PSN MediPass HMO
Understanding Doctor Because of n=359 n=380 n=1110
Differing Languages
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Never or Sometimes 323 90 1.59 355 93.4 1.27 1046.0 94.3 0.18
Usually 10 2.8 0.87 5 1.3 0.59 21.0 1.9 0.60
Always 26 7.2 1.37 20 5.3 1.15 43.0 3.9 0.43
PSN MediPass HMO
Q29. Doctor Explained Things so You n=36 n 7
Could Understand n=377 n=1
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Never or Sometimes 54 15.2 1.9 56 14.9 1.83 150.0 13.5 2.43
Usually 31 8.7 1.5 19 5 1.13 103.0 9.3 0.27

Always 271 76.1 2.26 302 80.1 2.06 857.0 77.2 0.09
PSN MediPass HMO
Q30. Doctor Showed Respect for PSN M s
What You Had to Say n=357 n=377
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Never or Sometimes 33 9.2 1.54 32 8.5 1.44 123.0 11.1 0.39
Usually 31 8.7 1.49 20 5.3 1.16 119.0 10.7 0.25
Always 293 82.1 2.03 325 86.2 1.78 865.0 78.1 0.09







APPENDIX E: Recipient Survey Satisfaction Data Tables


PSN MediPass HMO
Q31. Doctor Spent Enough PSN M s
Time With You n=356 n=377 n=1098
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Never or Sometimes 65 18.3 2.05 56 14.9 1.83 199.0 18.1 0.29
Usually 41 11.5 1.69 44 11.7 1.66 158.0 14.3 0.22
Always 250 70.2 2.43 277 73.5 2.28 742.0 67.5 0.10
PSN MediPass HMO
Q32. Rating of All Health Care, from All
Doctors and Health Providers n=355 n=378 n=1082
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
0 through 6 38 10.7 1.64 39 10.3 1.57 142.0 13.2 0.60
7 or 8 88 24.8 2.29 66 17.5 1.96 239.0 22.1 0.24
9 or 10 229 64.5 2.54 273 72.2 2.31 701.0 64.8 0.17
PSN __MediPass HMO
Q33. Needed an Interpreter to Speak with P
Doctor or Other Health Provider n=517 n=505 n=1546
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Yes 65 12.6 1.46 29 5.7 1.04 114.0 7.4 0.27

No 452 87.4 1.46 476 94.3 1.04 1432.0 92.6 0.07
PSN MediPass HMO
Q34. How Often You Received n=64 n=29 n=107
a Needed Interpreter
a Needed Interpreter Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Never or Sometimes 18 28.1 5.67 5 17.2 7.14 41.0 39.3 0.67
Usually 2 3.1 2.19 2 6.9 4.79 10.0 9.3 0.72
Always 44 68.8 5.84 22 75.9 8.09 56.0 52.5 0.37
PSN MediPass HMO
Q35. Do You Have a n=1418
Choice of Health Plans Standard
Standard
Frequency Percent Error
Yes _______1172.0 82.7 0.08
No 246.0 17.3 0.18







APPENDIX E: Recipient Survey Satisfaction Data Tables


PSN MediPass HMO
Q36. Use Current Medicaid Program for n=513 n=481 n=1161
All or Most of Health Care Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Yes 459 89.5 1.36 412 85.7 1.6 1137.0 98.0 0.08
No 54 10.5 1.36 69 14.3 1.6 23.0 2.0 0.54

Q37. Number of Months in a Row PSN MediPass HMO
Enrolled in This Program n=487 n=453 n=925
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Less than 3 Months 24 4.9 0.98 16 3.5 0.87 60.0 6.5 0.32
3 to 6 Months 35 7.2 1.17 25 5.5 1.07 148.0 15.9 0.23
7 Months to 1 Year 108 22.2 1.88 56 12.4 1.55 302.0 32.6 0.16
More than 1 Year 320 65.7 2.15 356 78.6 1.93 416.0 44.9 0.14

Q38. Chose Program Yourself, PSN MediPass HMO
or Were Told n=491 n=460 n=1133
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Chose Myself 221 45 2.25 229 49.8 2.33 778.0 68.7 0.10
Was Told 270 55 2.25 231 50.2 2.33 355.0 31.3 0.15
PSN MediPass HMO
Q39. Received Information About Program n=497 n=475 n=1126
When Enrolled
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Yes 314 63.2 2.17 268 56.4 2.28 742.0 65.9 0.10
No 183 36.8 2.17 207 43.6 2.28 384.0 34.1 0.15
PSN MediPass HMO
Q40. How Much of Given Information Was
Correct _n=281 n=245 n=713
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
All of It 181 64.4 2.86 166 67.8 2.99 438.0 61.3 0.13
Most of It 72 25.6 2.61 62 25.3 2.78 201.0 28.2 0.19
Some of It 26 9.3 1.73 17 6.9 1.63 66.0 9.2 0.33
None of It 2 0.7 0.5 0 0 9.0 1.3 0.87







APPENDIX E: Recipient Survey Satisfaction Data Tables


PSN MediPass HMO
Q41. Looked for Information in Written n=512 n=500 n=1530
Materials from Program
Materials from Program Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Yes 108 21.1 1.8 74 14.8 1.59 483.0 31.6 0.13
No 404 78.9 1.8 426 85.2 1.59 1047.0 68.4 0.09

Q42. How Much of a Problem to Find or PSN MediPass HMO
Understand Information
in Written Materials n=105 n=72 n=477
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Big Problem 26 24.8 4.23 5 6.9 3.02 40.0 8.4 0.45
Small Problem 15 14.3 3.43 7 9.7 3.52 86.0 18.0 0.31
Not a Problem 64 61 4.78 60 83.3 4.42 352.0 73.7 0.15
PSN MediPass HMO
Q43. Called Program's Enrollee Service n=515 n=501 n=1531
for Information or Help
for Information or Help Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Yes 115 22.3 1.84 76 15.2 1.6 563.0 36.7 0.11
No 400 77.7 1.84 425 84.8 1.6 968.0 63.3 0.09
Q44. How Much of a Problem to Get PSN MediPass HMO
Needed Help from Program's n=113 n=75 n=554
Enrollee Service
Enrollee Service Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Big Problem 34 30.1 4.33 12 16 4.26 111.0 20.0 0.27
Small Problem 20 17.7 3.61 13 17.3 4.4 103.0 18.5 0.27
Not a Problem 59 52.2 4.72 50 66.7 5.48 341.0 61.5 0.14
PSN MediPass HMO
Q45. Called or Written Program with n=516 n=503
Complaint or Problem Standard Standard
Standard Standard
Frequency Percent Error Frequency Percent Error
Yes 47 9.1 1.27 18 3.6 0.83
No 469 90.9 1.27 485 96.4 0.83







APPENDIX E: Recipient Survey Satisfaction Data Tables


PSN MediPass HMO

Q46. Length of Time to Resolve Complaint n=47 n= 17
Standard Standard
Frequency Percent Error Frequency Percent Error
Same Day 5 10.6 4.55 2 11.8 8.05
1 Week 3 6.4 3.6 3 17.6 9.53
2 Weeks 1 2.1 2.13 1 5.9 5.88
3 Weeks 1 2.1 2.13 2 11.8 8.05
4 or More Weeks 7 14.9 5.25 3 17.6 9.53
Still Waiting for Settlement 30 63.8 7.08 6 35.3 11.95
PSN MediPass HMO
Q47. Complaint or Problem Settled to n=47 n=17
Your Satisfaction Standard Standard
Standard Standard
Frequency Percent Error Frequency Percent Error
Yes 10 21.3 6.03 11 64.7 11.95
No 10 21.3 6.03 1 5.9 5.88
Still Waiting for Settlement 27 57.4 7.29 5 29.4 11.39
PSN MediPass HMO
Q48. Experience with Paperwork for n=507 n=502 n=1531
Program Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Yes 72 14.2 1.55 45 9 1.28 254.0 16.6 0.17
No 435 85.8 1.55 457 91 1.28 1277.0 83.4 0.08
_________PSN MediPass HMO
Q49. How Much of a Problem was the PSN Med s
Paperwork for Program n=71 n=44 n=249
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Big Problem 12 16.9 4.48 4 9.1 4.38 38.0 15.2 0.43
Small Problem 15 21.1 4.88 10 22.7 6.39 65.0 26.0 0.36
Not a Problem 44 62 5.8 30 68.2 7.1 147.0 58.9 0.22







APPENDIX E: Recipient Survey Satisfaction Data Tables


PSN MediPass HMO
Q50. Rating of Health Plan Now n=489 n=482 n=1480
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
0 through 6 117 23.9 1.93 71 14.7 1.62 262.0 17.8 0.60
7 or 8 100 20.4 1.83 78 16.2 1.68 354.0 23.9 0.20
9 or 10 272 55.6 2.25 333 69.1 2.11 862.0 58.3 0.15
PSN MediPass HMO

Q51. Rating of Overall Health Now n=509 _n=502 n=1532
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Excellent 56 11 1.39 88 17.5 1.7 223.0 14.6 0.19
Very Good 81 15.9 1.62 71 14.1 1.56 275.0 18.0 0.16
Good 146 28.7 2.01 129 25.7 1.95 465.0 30.4 0.13
Fair 133 26.1 1.95 120 23.9 1.91 404.0 26.3 0.14
Poor 93 18.3 1.71 94 18.7 1.74 164.0 10.7 0.22
PSN MediPass HMO
Q52. Smoked at Least 100 Cigarettes in n=516 n=502
Entire Life
Entire Life Standard Standard
Frequency Percent Error Frequency Percent Error
Yes 187 36.2 2.12 179 35.7 2.14
No 329 63.8 2.12 323 64.3 2.14
Q53. How Often PSN MediPass HMO
Q53. How O ften-----------------------------
Currently Smoke _n=187 n=179
Standard Standard
Frequency Percent Error Frequency Percent Error
Every Day 73 39 3.58 86 48 3.74
Some Days 32 17.1 2.76 40 22.3 3.12
Not at All 82 43.9 3.64 53 29.6 3.42







APPENDIX E: Recipient Survey Satisfaction Data Tables


PSN MediPass HMO
Q52 and Q53. Frequency Smoked n=516 n=502
Standard Standard
Frequency Percent Error Frequency Percent Error
Never 329 63.8 2.12 323 64.3 2.14
Have Quit 82 15.9 1.61 53 10.6 1.37
Some Days 32 6.2 1.06 40 8 1.21__
Every Day 73 14.1 1.54 86 17.1 1.68
PSN MediPass HMO
Q54. How Long Since You Quit Smoking n=81 n=53
Standard Standard
Frequency Percent Error Frequency Percent Error
6 Months or Less 10 12.3 3.68 6 11.3 4.39
More than 6 Months 71 87.7 3.68 47 88.7 4.39

Q55. Number of Visits that Doctor Advised PSN MediPass HMO
You to Quit Smoking _n=110 n=124
Standard Standard
Frequency Percent Error Frequency Percent Error
None 38 34.5 4.55 44 35.5 4.31
1 Visit 13 11.8 3.09 14 11.3 2.85
2-4 Visits 23 20.9 3.9 19 15.3 3.25
5-9 Visits 11 10 2.87 18 14.5 3.18
10 or More Visits 25 22.7 4.01 29 23.4 3.82
PSN MediPass HMO
Q56. Highest School Grade Completed n=505 n=500 n=1512
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
8th Grade or Less 96 19 1.75 79 15.8 1.63 296.0 19.6 0.17
Some High School, but Didn't Graduate 130 25.7 1.95 150 30 2.05 356.0 23.6 0.14
High School Graduate, or GED 183 36.2 2.14 192 38.4 2.18 526.0 34.8 0.12
Some College or
2-Year College Degree 71 14.1 1.55 63 12.6 1.49 206.0 13.6 0.18
4-Year College Degree or More 25 5 0.97 16 3.2 0.79 127.0 8.4 0.40







APPENDIX E: Recipient Survey Satisfaction Data Tables


Q57 and Q58. PSN MediPass HMO
Q57 and Q58.-----------------------------
Race/Ethnicity n=502 n=496 n=2199
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
White Non-Hispanic 44 8.8 1.26 22 4.4 0.93 812.0 36.9 0.93
Black or African American 262 52.2 2.23 203 40.9 2.21 615.0 28.0 2.2
Hispanic 190 37.8 2.17 270 54.4 2.24 734.0 33.4 2.1
Other 6 1.2 0.49 1 0.2 0.2 38.0 1.7 0.2
PSN MediPass HMO
Q57. Hispanic or Latino Origin or Descent n=508 n=502 n=1546
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
Yes 190 37.4 2.15 270 53.8 2.23 734.0 47.5 0.10
No 318 62.6 2.15 232 46.2 2.23 812.0 52.5 0.09
PSN MediPass HMO
Q58. Race n=469 n=450 n=1505
Standard Standard Standard
Frequency Percent Error Frequency Percent Error Frequency Percent Error
White 186 39.7 2.26 230 51.1 2.36 852.0 56.6 2.4
Black or African-American 277 59.1 2.27 218 48.4 2.36 615.0 40.1 2.4
Asian 3 0.6 0.37 0 0 18.0 1.2
Native Hawaiian or Pacific Islander 0 0 -1 0.2 0.22 9.0 0.6 0.4
American Indian or Alaska Native 3 0.6 0.37 1 0.2 0.22 11.0 0.7 0.4




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