Best Practices and Innovations in Medicaid Managed Long-Term - - PowerPoint PPT Presentation

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Best Practices and Innovations in Medicaid Managed Long-Term - - PowerPoint PPT Presentation

Oct 16, 2022 317 likes •672 views

Best Practices and Innovations in Medicaid Managed Long-Term Services and Supports (MLTSS): By: Sarah Swanson, Denise Rozell, John Tschida AUCD Webinar, 2020 Presenters: Denise Rozell, JD Director of Policy Innovations Association of

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Best Practices and Innovations in Medicaid Managed Long-Term Services and Supports (MLTSS):

By: Sarah Swanson, Denise Rozell, John Tschida AUCD Webinar, 2020

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Presenters:

Denise Rozell, JD Director of Policy Innovations Association of University Centers for Disabilities Sarah Swanson, MPH Assistant Professor Community and Family Resource Coordinator UNMC Munroe-Meyer Institute John Tschida, MA Interim Director Association of University Centers for Disabilities

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Two Policy Briefs:

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Background:

States Historically Have Managed Medicaid Home and Community Based Services (HCBS) Medicaid Waiver Programs

Medicaid (medical services) Medicaid (non-medical services)

Home & Vehicle Modifications Respite Independent Living Skills Training In-home care Physical Therapy Occupational Therapy Applied Behavioral Analysis

Hospital services

Durable Medical Equipment Mental Health Job Coaching

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Background:

Medicaid (medical services) Medicaid (non-medical services)

Home & Vehicle Modifications Respite Independent Living Skills Training In-home care Physical Therapy Occupational Therapy Applied Behavioral Analysis

Hospital services

Durable Medical Equipment Mental Health Job Coaching

State contracts with Managed Care Organization to Manage Services

N e w

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Source: http://www.advancingstates.org/initiatives/managed-long-term-services-and- supports/mltss-map (2020)

Current Picture:

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MLTSS Growth:

Year Number of states implementing MLTSS tripled 2004

8

2018

24

Source: Truven, 2018

Year Number of state MLTSS programs more than doubled 2012

19

2017

41

Source: MACPAC, 2018

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Individuals with IDD are No Longer Carved Out (Excluded)

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Why are States Moving to MLTSS?

Medicaid expenditures are becoming one of the largest budget lines for states and the aging population is adding urgency to state efforts to reform LTSS.

Sources: Health Management Associates, National Committee for Quality Assurance, 2017

  • MLTSS can provide states budget predictability.
  • MLTSS will improve care coordination and make things simpler for

the recipient.

  • MCOs will provide services that support the whole person and

improve the individual’s quality of life.

  • MCOs can provide services that Medicaid cannot.
  • MCOs can help transition individuals in nursing or institutional

setting to home and community based settings.

  • MLTSS will reduce Medicaid expenditures.
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A Problem or An Opportunity?

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Roles and Contracting Processes Change

States are responsible for monitoring and holding MCOs accountable…

After Managed Care

State MCO Medical Providers MCO Community Based Organizations

States contract with Managed Care Organizations (MCOs). MCOs in turn, contract with both medical and non-medical providers Before Managed Care

State Medical Providers Community Based Org.

States contract directly with providers

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New Services or Innovations:

In many states, managed care is viewed as the chief vehicle for transforming the delivery of Medicaid services to beneficiaries with disabilities and chronic illnesses, and states are using the contracts with MCOs to influence service delivery and drive systems change.

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Social Determinants of Health: Critical to Improving Health Outcomes

“There is growing recognition among policymakers that integrating health care with social supports and services is critical to improving broad population health, advancing health equity, and reducing health care spending.”

Source: https://www.chcs.org/topics/soc ial-determinants-of-health/

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Role of the AUCD Network in MLTSS Implementation

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Inform and Involve Stakeholders

Opportunities for the AUCD Network:

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Role of AUCD Network

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Opportunities for the AUCD Network:

UCEDDs and LENDs are uniquely positioned… If you can help the MCO meet with required performance measures

Contract with the MCOs

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Opportunities for the AUCD Network:

Research and Evaluation

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  • Involving Stakeholders
  • Building a “Single Entry

Point/No Wrong Door”

  • Training to Community-Based

Organizations on how to Contract with MCOs

  • Developing Ombudsmen

Programs

Opportunities for the AUCD Network:

Build a Solid Framework

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  • Support to Family

Caregivers

  • Technology Innovations
  • Strategies to Build the

Direct Workforce

  • Employment Supports
  • Accessible Housing

Opportunities for the AUCD Network:

Best Practices

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Pilot New Models and Programs

New Programs/Models Focus Support Waivers

Limited in their services but offer budget predictability for states Set budget and a set number of slots.

Provider-led Models

Take on risk but share in savings

Accountable Care Organizations

Provider-led organizations who are responsible for the quality and the cost of care for its members

Opportunities for the AUCD Network:

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Take Away Message:

  • I. Medicaid Managed Care- It’s Here to Stay

“Don’t fight it. Get onboard and shape it.”

  • II. People with Disabilities, and Families Need to Be

Informed and Involved “UCEDDs and LENDs can lead the charge”

  • III. Opportunity for New Innovations

“States are using MLTSS to transform systems. Be involved and learn from what has already been done, but be creative and create new programs.”

  • IV. Opportunities for Contracting with MCOs

“Know the Performance Measures. They dictate

  • payment. Payments dictate priorities.”
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Two Policy Briefs:

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A U C D

Association of University Centers on Disabilities

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What’s happened since?

  • Number of states with MLTSS about the

same

  • But the numbers are growing: people in

MLTSS plans grew 63% from 2016 to 2020.

  • Overall, spending on LTSS is increasing.
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A U C D

Association of University Centers on Disabilities

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What’s happening now?

  • Expansion of MLTSS in states that have it

– PA: Expansion of Community HealthChoices statewide. – NJ: Transitioned coverage of long-term residential services for substance use disorder treatment from fee-for-service to managed care. – NY: Experimenting with multiple models, especially for IDD population. – ID, IL, TN: Expansions in geography or population.

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A U C D

Association of University Centers on Disabilities

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What’s happening now?

  • Delays elsewhere

– NC: Department of Health and Human Services (DHHS) announced the statewide transition to managed care will be suspended.

  • ‘Medicaid Transformation’ is the law, but there’s

disagreement on how/whether to implement it.

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A U C D

Association of University Centers on Disabilities

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What’s Next?

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A U C D

Association of University Centers on Disabilities

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A U C D

Association of University Centers on Disabilities

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Pennsylvania Waiver

  • Expand habilitation service settings to private homes;
  • Allow for remote habilitation therapy and counseling,

assessments, and service coordinator meetings through phone or videoconferencing;

  • Modify provider qualifications to allow more flexibility

reassigning staff;

  • Relax staffing ratios and number of individuals served due

to staffing shortages; and

  • Make retainer payments for personal assistance services for

15 days when the individual is hospitalized or absent from home due to COVID-19.

https://nashp.org/states-modify-medicaid-home-and-community- based-waivers-to-respond-to-covid-19/

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A U C D

Association of University Centers on Disabilities

30

Why is this happening?

  • States are looking to preserve access to

services.

  • Reducing regulatory burden.
  • Increasing flexibility (e.g. telehealth or in-

home service authorizations).

  • In some cases, capitalizing on increased

federal payments (FMAP).

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A U C D

Association of University Centers on Disabilities

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Budget Trouble Is Here

  • NY: 1.5% Medicaid provider rate cuts

went into effect last week, affecting home care and other LTSS services.

  • VA: Medicaid population has grown by

30,000 since COVID outbreak. (AP, 5/21)

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A U C D

Association of University Centers on Disabilities

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Budget Trouble Is Coming

  • LTSS demand high; need is growing.
  • State and federal budgets strapped next

year.

  • Main state budget expenditures: K-12

education and health care.

  • Main sources of income: property, sales,

and income taxes.

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A U C D

Association of University Centers on Disabilities

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MLTSS Expansion?

  • Will states look to MLTSS for savings?
  • Disability organizations and experts need

to be engaged.

  • Programs succeed with diverse

stakeholder participation.

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A U C D

Association of University Centers on Disabilities

34

Questions?