Managed Care

As part of Mathematica’s ongoing evaluation project of section 1115 demonstrations, they have released their interim findings on MLTSS programs. This preliminary report looked closely MLTSS programs in New York and Tennessee and found mixed results regarding the goals of reducing hospitalizations and rebalancing care. Mathematica aims to release a final report on the effectiveness of MLTSS in 2019.

The Spring 2018 issue of Generations, the quarterly journal of the American Society on Aging, is divided into three main parts. These three sections are building community partnerships, building business practices, and examples of successful CBO use of business acumen. This issue also has a special focus on how the social determinants of health influence the experience of older adults in the community.

This report from AARP's Public Policy Institute is part of a series of papers focusing on innovative strategies. It explores the benefits of self-directed care and looks at best practices used in Texas, Iowa, Wisconsin, and Florida. The report also provides a toolkit for educational and training purposes to help states improve and expand upon their self-directed LTSS programs.

CMS recently released a 2017 update to its 2012 MLTSS inventory, compiled by Truven Health Analytics. This study reviewed available information about the status of Medicaid MLTSS programs, and provides updates on the prevalence of MLTSS programs, total enrollment, and specific program design elements as of August 2017. The report surveys the landscape of MLTSS programs across the country, provides detailed summaries of each MLTSS program, and identifies national trends.

MACPAC’s 2018 Report to Congress on Medicaid and CHIP addresses managed care, telehealth, and disproportionate share hospital (DSH) payment. The report presents recommendations and analyses backed up by analyses of administrative data and reviews of federal and state policies in each of these areas.

Presentation from the 2017 HCBS Conference on "Compliance Isn’t Quality: Building an Authentic Quality Framework in Managed Long-Term Services and Supports Programs".

This report examines state and federal oversight of assisted living services in Medicaid. Individuals receiving long-term care services from Medicaid in community residential settings is expected to grow. This report describes state spending on and coverage of these services; describes how state Medicaid agencies oversee the health and welfare of beneficiaries in these settings; and examines the extent that CMS oversees state Medicaid agency monitoring of assisted living services.

The Government Accountability Office (GAO) examined states’ needs assessment processes for provision of long-term services and supports. GAO studied six states that differed in the following ways: assessment tools in use, participation in federal initiatives, HCBS delivery systems, and geographic location. GAO also reviewed federal requirements and documents and interviewed CMS officials and stakeholders.

In this presentation, the National Committee for Quality Assurance (NCQA), shared insights from its research on person-centered goals for people with complex care needs and tools for CBOs to become more effective partners with health plans, including how to effectively measure quality improvement and implement quality improvement initiatives.

During this webinar, a panel of experts provide real-world strategies that CBOs can use to effectively expand access to their services, work with state Medicaid programs, contract with managed care, and ensure sufficient reimbursements.