Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Dr. Jack L. Michael

Second Advisor

Dr. David Lyon

Third Advisor

Dr. Norman Peterson

Fourth Advisor

Dr. David Sluyter


This study provides a detailed analysis of the daily service delivery records before and after the introduction of a Medicaid Billing Form at a day-activity center for developmentally disabled adults. The form required therapists to record daily service delivery (in 15-minute units) to Medicaid eligible clients. There were 38 clients, 23 Medicaid and 15 non-Medicaid, and four therapists. The data showed, for three of the four therapists, a clear and large increase in reported service delivery to Medicaid clients and a smaller increase to non-Medicaid clients. Six months after the introduction of the Medicaid Billing Form the therapists were required to record service delivery to non-Medicaid clients on the same type of form. This resulted in an increase in reported service delivery to non-Medicaid clients, but only for one of the four therapists. Five months later the facility director announced a change in facility financing which made Medicaid reimbursement even more important for the financial well-being of the center than it had been previously. Simultaneously the use of the Medicaid Billing Form with the non-Medicaid clients was discontinued. Data were available for only three of the four therapists, and two showed a drop in recorded service delivery to non-Medicaid clients. There were no clear effects on service to Medicaid clients.

A questionnaire was devised for measuring client attractiveness, and this variable was studied in relation to reported service delivery and also in interaction with the other independent variables. No general effect was seen, although several relations unique to the individual therapists were suggested by the data.

Access Setting

Dissertation-Open Access