All States/Territories

An FMS Membership Issue Brief Summary, this issue brief presents existing fraud detection and prevention methods that directly address a selection of the recommendations offered in the 2012 report Personal Care Services: Trends, Vulnerabilities, and Recommendations for Improvement released by the Department of Health and Human Services Office of Inspector General (OIG).

The purpose of this study was to describe the two ways in which Medicaid offers personal care services to low-income Americans: Medicaid Title XIX Personal Care Services (PCS) optional state plan benefit; and the Medicaid 1915(c) Home and Community-Based Services (HCBS) waivers program. A summary of the findings of this study are presented here as well as the article that appeared in the Health Care Financing Review, Summer 2001.

This innovative disability and health data tool uses data from the Behavioral Risk Factor Surveillance System (BRFSS) to identify disparities in health between adults with and without disabilities. Find data on a range of health indicators for your state and compare the health of adults with and without disabilities and certain health conditions. Maps, data tables and state profiles are available.

This bulletin reviews policy when Medicaid funding is available for certain administrative costs related to activities conducted by state Long Term Care Ombudsman (LTCO) programs that benefit the state's Medicaid program. It also summarizes the basic requirements for Medicaid administrative claiming of LTCO program activities and provides a link where states and LTCO programs can find more information regarding specific program activities that may be eligible for Medicaid administrative funding.

This summary draws attention to some of the most important aspects of CMS’s recently released guidance for states and stakeholders on the use of managed care for long-term services and supports (MLTSS) as well as transitioning LTSS providers into managed care systems and developing MLTSS programs. CMS identified 10 important elements that should be incorporated into managed LTSS and this document can assist consumers and their representatives in understanding these elements.

This issue brief uses the most recent comprehensive data, from 2009, to examine the characteristics and costs of dual-eligible beneficiaries. The report also examines the different payment systems that Medicare and Medicaid use to fund care for dual-eligible beneficiaries and recent efforts at the federal and state levels to integrate those payment systems and coordinate the care between both programs. Given the high cost of dual-eligibles, legislative solutions are reviewed.

In an effort to assist state agencies in planning for the specific behavioral health needs of emerging populations in their state, this toolkit provides state and national estimates of behavioral health disorders and program utilization, as well as step-by-step instructions to generate projections of health benefits, services and providers that will need to be addressed in the future. This resource can be helpful for mental health and substance use agencies, health plans, and Medicaid agencies.

The Patient Protection and Affordable Care Act (ACA) requires large employers to provide affordable healthcare coverage to full-time workers as of January 1, 2014. In preparation for the implementation of the the ACA, the NRCPDS looked into how participant direction will be impacted by the new legislation. As a consequence, in the context of participant direction, the employer mandate is likely to apply to certain Financial Management Services (FMS) providers.

This scan was designed to understand facilitators and barriers to self-direction in behavioral health, ascertain interest among stakeholders, adapt the model and outcome measures to better fit the needs of behavioral health consumers, and develop recommendations to inform next steps. The scan was a joint effort conducted over 18 months (Sept 2011-Feb 2013) by researchers from the National Center for Participant-Directed Services, Human Services Research Institute, and University of Maryland.

This report provides background on MLTSS to brief the intellectual and developmental disability community, as well as the President and the Secretary of the Department of Health and Human Services, on managed care and changes in LTSS administration so that they may take action and influence outcomes. The report also contains a number of recommendations related to disability stakeholder engagement, choice and self-determination, consumer protections and rights and quality measurement.