Managed Care

As almost half of the States have implemented MLTSS programs, community-based organizations, will be significantly impacted. At the 2013 HCBS conference, ADvancing States, with support from the SCAN Foundation, held a day-long intensive to discuss these impacts. This report outlines 5 discrete roles that CBOs are well-suited to play in MLTSS programs using as a reference point CMS’ 2013 guidance on MLTSS program design and implementation. To request a hard copy version, email Ali Diaz at adiaz@advancingstates.org.

Community-based organizations will be notably impacted by States' implementation of MLTSS programs. Case studies on ombudsman programs and care/service coordination–culled from the MLTSS intensive at the 2013 HCBS Conference–complement the issue brief on CBO readiness. The ombudsman case studies highlight activities in Wisconsin, Hawaii, & Minnesota, while the care/service coordination case studies discuss CBO experiences in Massachusetts & Ohio. Both studies feature successful CBO practices.

The lack of recognized standards for what constitutes sufficient monitoring has hindered efforts to assess the effectiveness of state oversight of managed care plans. This brief describes an approach used to evaluate state oversight of a new Medicaid managed care program for individuals with disabilities in Washington. The approach evaluates both the type and vigor of monitoring activities by the state and the degree to which the state's activities achieved their desired program outcomes.

This report developed new estimates of the program's effects for Program of All-Inclusive Care for the Elderly (PACE) enrollees in eight states based on more recent data. PACE plans provide coordinated acute and long-term care services to nursing home eligible seniors residing in the community.

In this report, the GAO examined claims, expenditure, and quality data from Dual Eligible Special Needs Plans (D-SNPs) during 2009. The GAO notes that D-SNPs with higher levels of Medicare and Medicaid integration performed better on quality outcomes but did not reduce utilization of costly Medicare services. The GAO concludes that CMS projected savings from the Financial Alignment Demonstration and other initiatives to integrate care for dual eligible beneficiaries may be overstated.

The OIG report examines state standards and requirements for network adequacy and access to care. The report was based on surveys and interviews of state officials, CMS employees, and External Quality Review Organizations. In the report, OIG notes that state standards on access to care vary widely, and that state oversight of health plans also varies. Based on its findings, OIG offers recommendations to CMS in the report.

This paper identifies the concerns and considerations in transitioning traditional LTSS providers from fee-to-service models to a managed care program.The findings of the study are based on qualitative interviews conducted with a variety of stakeholders, including state Medicaid program officials, representatives from managed care companies, LTSS providers, LTSS provider associations, and private consultants.

This white paper provides an inventory of all current MLTSS programs and a projection of future programs as of July 2012. The report includes state-by-state results and synthesizes findings across states, reporting national enrollment, characteristics of contractors and multiple program features.

This tool promotes consumer-focused MLTSS by making it easier to identify weaknesses and promote better practices. The tool combines a checklist for assessing MLTSS with examples of practices, policies or contract language that implement the criteria.

This report fulfills NCD’s statutory mandate to annually report and make recommendations concerning the state of disability policy in the United States. Specifically, the 2014 Progress Report focuses on seven key areas: the Convention on the Rights of People with Disabilities (CRPD), employment access and inclusion, subminimum wage, education outcomes, Medicaid managed care, mental health care, and data trends in disability policy.