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Paying for the Transition from Pediatric to Adult Health Care

Organization: National Alliance to Advance Adolescent Health

Primary Contact: Peggy McManus

Grant Amount: $133,572 for 21 months

Date Awarded:

Date Completed:

Purpose

Lack of payment is one of the most significant barriers to providing quality transition services for youth with special health care needs. Billing codes are not specific to transition, and transition services often are not required in managed care contracts. Based on a previous report recommending value-based transition payment, this grant will enable the National Alliance to Advance Adolescent Health to identify and assist commercial insurers and Medicaid programs to pilot test alternative payment strategies. The funding also will support development of related communication and technical assistance materials to be disseminated nationally.

Outcome

The National Alliance to Advance Adolescent Health (NAAAH) identified and engaged eight commercial insurers and Medicaid programs to pilot test alternative payment strategies. A value-based payment guide, as well as two related webinars, were developed and disseminated. NAAAH also provided technical assistance that was highly valued by participants. Genuine progress was made in two large programs, in Texas and Florida, and further work is planned.

Related Resources

This guide contains a step-by-step approach for state Medicaid and managed care organizations as well as commercial payers interested in starting a value-based payment initiative around pediatric-to-adult transitional care. Each of the steps includes several issues and strategies to consider, tips, and examples.

To assist state Medicaid agencies and managed care organizations in improving access to recommended pediatric-to adult health care transition services for their enrollees, this report offers specific options for managed care contract language that can be incorporated into standard and specialty contracts.