Managed LTSS Program
The state is developing a state-wide Medicaid managed care program for the delivery of long-term services and supports, with a July 2015 target implementation date. MLTSS will include physical and behavioural health care, dental care, and pharmacy coverage. (Source: State Medicaid MLTSS website, link no longer available)
On May 13, 2014, Nebraska Medicaid announced the temporary suspension of its work on a statewide MLTSS program in order to devote resources to the state’s July 2014 Balancing Incentive Program grant application. The state’s new MLTSS target implementation date is January 2017. (Source: State Medicaid MLTSS website, link no longer available; State Medicaid MLTSS PowerPoint, link no longer available 5/7/2014; HMA Weekly Roundup, 5/21/2014)
On October 21, 2015, Nebraska issued a request for proposals (RFP) for statewide contracts to integrate services under a managed care delivery system for approximately 240,000 Medicaid beneficiaries. The contracts will:
- Integrate care for physical and behavioral health, as well as pharmacy benefits;
- Enroll children, adults, ABD, dual eligible individuals, and enrollees needing long-term care that are institutionalized or in HCBS; and
- Continue to carve out long-term services and supports, as the state still plans on implementing a full MLTSS program at a later date.
Proposals must be submitted to the state by December 22, 2015, with a scheduled start date of January, 2017. (Source: HMA Roundup 10/21/2015; RFP)
The following companies responded to Nebraska's Request for Proposals (RFP) regarding its full risk, capitated Medicaid managed care program to manage physical and behavioral health, and pharmacy services: AmeriHealth, Inc.; Coventry Health Care of Nebraska, Inc.; Meridian Health Plan; Nebraska Total Care, Inc.; UnitedHealthcare of the Midlands, Inc. and; WellCare of Nebraska, Inc. (Source: Nebraska.gov 1/5/2016)
On March 8, 2016, the Nebraska Department of Health & Human Services (DHHS) announced a change to the awardees for the three managed care organizations set to administer the state’s Heritage Health Program. Previously, the three MCOs chosen were United HealthCare Community Plan, Nebraska Total Care (Centene), and Aetna Better Health of Nebraska. After a limited re-evaluation, however, the Division of Medicaid and Long-Term Care replaced Aetna with WellCare, due to a scoring error in the evaluation process. (Source: Press Release 3/8/2016)
On May 9, 2016, the Nebraska Department of Health and Human Services (DHHS) announced it had executed a contract with Automated Health Systems Inc. (AHS) to serve as its Medicaid enrollment broker. AHS will connect Heritage Health beneficiaries—Nebraska’s integrated managed care system—with one of three MCOs: Nebraska Total Care, United Healthcare of the Midlands, and WellCare of Nebraska. Beginning in the fall AHS will also be assisting beneficiaries with choosing a primary care provider (PCP). AHS will be serving an estimated 231,000 enrollees. Heritage Health coverage officially takes effect January 1, 2017. (Source: NE DHHS 5/9/2016)
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On March 7, 2017, the Nebraska Department of Health and Human Services (DHHS) released a draft long-term care (LTC) system redesign plan. The plan is a follow up to a concept paper released on January 22, 2016. The draft redesign plan was prepared for DHHS by Mercer Government Human Services Consulting and ADvancing States. . The redesign plan encourages DHHS to build upon the states’ current Heritage Health managed care program, which was implemented on January 1, 2017, and integrates services for behavioral and physical health, and pharmacy benefits by expanding the scope of existing MCOs to include coverage for LTC – e.g., LTSS – for individuals currently enrolled in Nebraska’s existing Medicaid HCBS programs. The states’ current MCOs are Nebraska Total Care (Centene), UnitedHealthcare, and WellCare. DHHS’ existing HCBS programs are as follows:
The draft redesign plan also recommends including individuals in nursing facilities and assisted living homes under MLTSS in order to avoid creating any financial disincentives for HCBS. Implementing MLTSS can be achieved through amendments to the states’ existing 1915(b) and 1915(c) waivers. Finally, the plan recommends a phased implementation approach for MLTSS. A tenative timeline pro[osed to implement for the elderly and disabled populations on Jabuary 1, 2019, and July 1, 2019 for the I/DD populations. DHHS is currently conducting an extensive stakeholder engagement process. After the comment period ends in May 2017, a final redeisgn plan will be devloped that incorporates public comments and feedback. (Source: Draft LTC Redesign Plan 3/7/2017; Concept Paper 1/22/2016) On July 28, 2017, Omaha.com reported on the Nebraska Department of Health and Human Services (DHHS) priorities for the coming year that are contained in the department’s second business plan. The state has 20 priorities contained within five key areas: integrating services, leveraging technology, increasing efficiency, prioritizing prevention, and promoting independence. One of Nebraska DHHS’ priorities is to move toward a MLTSS system for the frail elderly and persons with disabilities, in order to provide greater opportunities for individuals to be served in the community as opposed to institutions. (Source: Omaha.com 7/28/2017) On August 9, 2017, the Nebraska Department of Health and Human Services (DHHS) published a final long-term care (LTC) redesign plan, which was prepared for the state by Mercer Government Human Services Consulting, and ADvancing States. The report is the final version of the draft LTC redesign plan released in March 2017, which was discussed at length in the April edition of the State Medicaid Integration Tracker©. Mercer/NASUAD continue to recommend that the state move towards an MLTSS system utilizing existing MCOs, with phased-in implementation over a period of 18 months for older adults and individuals with disabilities, and a period of over 27 months for individuals with I/DD. (Source: Final LTC Redesign Plan 8/9/2017; April State Medicaid Integration Tracker 4/7/2017) |
Balancing Incentive Program
On July 31, 2014, Nebraska submitted to CMS a Balancing Incentive Program application. On September 11, 2014, CMS approved the BIP application. The period for performance for the grant award is October 1, 2014 through September 30, 2015. (Source: State BIP website)
BIP Application (7/31/2014)
CMS Approval Letter (9/11/2014)