Managed Long Term Services and Supports, an update Brian Stever, - - PowerPoint PPT Presentation
Managed Long Term Services and Supports, an update Brian Stever, BSN RN Director of Health Informatics Presbyterian Senior Living April 28, 2016 Agenda What is Managed Long-Term Services and Support, MLTSS? Why this focus on
April 28, 2016
Brian Stever, BSN RN
Director of Health Informatics Presbyterian Senior Living
2
3
delivery of long-term services and supports (LTSS) through capitated Medicaid managed care programs.
Medicaid programs and contractors. The contractors receive capitated payments (flat, fixed fees per participant based on their aggregate costs) for LTSS and are accountable for the health and welfare of participants through the delivery of services and supports that meet quality and other standards set in the contracts.
Proposal, RFP, that was released on March 1st
5
with physical disabilities to remain in their homes.
implement a Managed Long-Term Services and Supports (MLTSS) program for older Pennsylvanians and adults with physical disabilities called Community HealthChoices (Community Health Choices).
6
Participants through improved person-centered service planning and performance incentives.
healthcare, including Medicare and MA services for Dual Eligible individuals.
service delivery (i.e. patient centered medical homes).
in rural and underserved areas of the Commonwealth.
7
Commonwealth’s statewide mandatory Medicaid managed care program through which Participants will receive Medical Assistance (MA) physical health services and Long Term Services and Supports (LTSS). Community Health Choices will serve the following Participants:
– Adults age 21 or older who require MA LTSS (whether in the community or in private or county nursing facilities) because they need the level of care provided by a nursing facility or an intermediate care facility for individuals with
– Dual Eligibles age 21 or older whether or not they need or receive LTSS.
8
– Long-term Services and Supports in the form of Nursing Facility Services or Home and Community- Based Services. – Physical Health Services such as, but not limited to:
9
Objectives:
– Includes:
Medicare, Medicaid LTSS, Medicaid Physical Health Services, and Medicaid Behavioral Health
coordinating needed Covered Services and non- Covered Services such as social, housing, educational and other services and supports.
assessed needs are being met.
Impact studies of early MLTS S
Focus on Community- Based LTSS
Hospital Use Declined
programs where studied
Physician Services Increased
Outcomes Improved (Less often studied)
L TSS in a person’s home.
11
Nursing Facility Services
Necessary NF services, including bed hold days and up to fifteen (15) days per hospitalization and up to thirty (30) Therapeutic Leave Days per year if a Participant is admitted to a NF or resides in a NF at the time of Enrollment.
monitor for completion of all NF related processes, including but not limited to: PASRR process, specialized service delivery, Participant’s rights, patient pay liability, personal care accounts or other identified processes.
12
Nursing Home Transition (NHT) is located in the Draft Agreement, Section V: Program Requirements, L. Nursing Home Transition
CHC-MCOs. CHC-MCOs will have the option to contract with existing NHT providers. This community is generally a less expensive venue for services. CHC-MCOs have an inherent interest to transition participants into the community.
for those residents in LTC that would like to transition back to their homes or other community-based settings.
13
and supports (LTSS) to a capitated managed care (MC) model
southwestern Pennsylvania.
19
15
16
17
18
19
20
Case Mix in the state of Pennsylvania will cease to be. The first six (6) months of the process going live in any region will allow for the continuation of the current process while the MCOs set up their new processes.
21
change
conversations with the MCOs that have been engaged in the process
22
about the services that communities can provide to residents that we serve. For example,
and a pool
24
variety of levels of care, make sure that the MCOs know and understand that fact
the MCOs
25
http://www.dhs.pa.gov/citizens/communityhe althcho ices/index.htm#.VkyJ23arRhF
http://www.dhs.pa.gov/communitypartners/inf
htm#.V kyKAnarRhE
26