6/9/2015 ABC’s of Managed Care
7/14/2015 Person-Driven Services in Managed Long-Term Services and Supports
10/5/2015 Update on Managed Long-Term Services and Support
Person-Driven Services in Managed Long-Term Services and Supports
- Implications of Managed Long-Term Services and Supports (National Council on Disability)
- Participant-Directed Services and Supports Programs: A Five State Comparison
- Key Themes in Capitated Medicaid Managed Long-Term Services and Supports Waivers
Potential Benefits of Medicaid Managed Long-Term Services and Supports (LTSS)
- Can shift services from institutional care to home and community based care
- Can improve coordination of services, especially in states where MCOs provide acute and behavioral care and LTSS
- Stabilize State Costs and make budgeting more predictable
Potential Risks of Medicaid Managed Long-Term Services and Supports
- Loss of essential services that could lead to illness or institutionalization
- Reduction of capitation rate paid to MCOs below the level needed to maintain adequate access to care
- Move to “medical model” if administered by health insurers
- MCOs reducing services or cutting payments to providers
- May significantly reduce consumer choice of treatment locations and providers
- MCOs may challenge consumer-directed services
Considerations for reducing risks:
- Ensure real consumer and community stakeholder input in the system design and monitoring.
- Ensure appropriate trainings and supports to enable use of person-directed options.
- Ensure transparency of all contracts by making them public and require reporting on finances, reserves, provider rates and patient outcomes.
- Explicit priority included in MCO contracts for least restrictive settings that incorporate payment methods and performance measures that incentivize community based care.
- Include clear definitions and terms of any restrictive rules like services that are considered “necessary”.
- Ensure a broad range of services is included in LTSS that include both traditional and non-traditional services like person-directed services, family support, home modifications, behavioral health support, peer support and recovery services without waiting lists or caps.
- Ensure diverse, robust and adequate provider networks who are culturally and linguistically competent, accessible and trained in independent living and recovery models to ensure quality, choice and continuity of care.
- Require MCOs to do person-directed models that maximize consumer control, choice and independence as opposed to the traditional agency or medical model
- Ensure quality of care through care coordination both within LTSS and with other parts of the health system using community groups that are independent, conflict-free care coordinators experienced in working with seniors and people with disabilities that are not providers nor employees of the MCO.
- Ensure performance measures specific to LTSS that does not jeopardize quality of care in pursuit of savings by linking payments to quality of service through incentives or penalties.
- Require standardized conflict free assessments of LTSS plans with a focus on consumer goals.
- Ensure Assessment of MCOs in ability and knowledgeable about needs and services of population utilizing LTSS